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LIBRARY OF CONGRESS. 



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UNITED STATES OF AMERICA. 



J. 



A PRACTICAL TREATISE 



ON 



MATERIA MEDICA 



AND 



THERAPEUTICS 



BY 

EOBERTS BAKTHOLOW, M. A., M. D., LL. D. 

Professor of Materia Medica, General Therapeutics, and Hygiene, in the Jefferson Medical 
College of Philadelphia ; Fellow of the College of Physicians ; Member of the 
American Philosophical Society ; Honorary Fellow of the Royal Medical 
Society of Edinburgh ; Honorary Member of the Societe Medico-pratiques 
de Paris, and of various National, State, and County Medical Societies. 
Author of a Treatise on the Practice of Medicine ; of a Treatise on 
Medical Electricity ; of a Manual of Hypodermatic Medica- 
tion ; of the Russell and Jewett Prize Essays, and Prize 
Essays of the American Medical Association and 
of the Rhode Island Medical Society, etc. 




SEVENTH EDITION, BE VISED AND ENLARGED 




new yoke: 
d. appleton and company 

1889 



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<v X 



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Copyright, 1876, 1877. 1879, 1881, 1883, 1887, 1 
By D. APPLETON AND COMPANY. 



5 



TO THE MEMORY OF 

FATHER, MOTHER, AND BROTHERS, 

BY THE SUEVIVOB. 



PREFACE TO THE SIXTH EDITION. 



This edition of my treatise contains much new matter. The 
domain of Pharmacology is rapidly enlarging by the contribu- 
tions of chemistry and by the new remedies brought forward by 
dealers with a view to profit. When a new remedy is announced, 
its physiological actions are immediately studied and defined. Clin- 
ical experience is then acquired, and in all parts of the world 
the new agent is applied to the treatment of diseases, and a ver- 
dict rendered after trials that very often give an erroneous notion 
of the real powers of the medicament. The earliest announce- 
ments are not unfrequently given forth by medical quidnuncs, 
who are more enthusiastic than logical, more sensational than ex- 
act, and more concerned to advertise their own doings than to 
give expression to faithful observations. 

So numerous and serious are the fallacies of experiment and 
of clinical experience, that an author whose function it is to re- 
cord the results, must maintain a judicial attitude, and examine 
into the pretensions of new remedies with the same jealous care 
that he defends the older medicaments against the assaults of 
medical iconoclasts. Much sifting of the material is necessary. 
Some of the new agents possess the virtues ascribed to them by 
their enthusiastic promoters ; others seem hardly to justify their 
appearance in the role of remedy ; and not a few probably are 
worthless for any purpose. 

As in previous issues of this work, I have sought to give the 
facts, and to some extent the current opinions of the time, on the 
new remedies ; but as far as possible demonstrable incongruities 



yi PREFACE TO THE SIXTH EDITION. 

of opinion and of practice have been omitted. Only by actual 
inspection in all parts of the work as it now appears can the 
numerous additions to the individual remedies be seen. The new 
contributions are assigned to places according to their physiologi- 
cal relations. The additions thus made to the work occupy 
nearly one hundred pages, notwithstanding I have sought to take 
up as little space as could contain the actual facts. It was the 
more necessary to make numerous additions, because this issue of 
the treatise should have appeared a year ago ; but my occupations 
— including the preparation of a new edition of my " Practice " — 
were so numerous and exacting, that I could not accomplish the 
task at an earlier date. I now place the sixth edition before my 
readers and the medical profession in general, with the expression 
of my hope that it will deserve and maintain the place in their 
esteem which it has always held. 

R. B. 
1527 Loctjst Street, Philadelphia. 






PREFACE TO THE FIFTH EDITION. 



The appearance of the sixth decennial revision of the " United 
States Pharmacopoeia " has imposed on me the necessity of pre- 
paring a new edition of this treatise. I have accordingly adapted 
the work to the official standard, and have also given to the whole 
of it a careful revision, incorporating the more recent improve- 
ments in the science and art of therapeutics. Many additions 
have been made, and parts have been rewritten. These additions 
and changes have added abont one hundred pages to the body 
of the work, and increased space has been secured in some places 
by the omission of the references. In the new material, as in the 
old, practical utility has been the ruling principle, but the scien- 
tific aspects of therapeutics have not been subordinated to a utili- 
tarian empiricism. In the new matter, as in the old, careful 
consideration has been given to the physiological action of reme- 
dies, which is regarded as the true basis of all real progress in 
therapeutical science; but, at the same time, I have not been un- 
mindful of the contributions made by properly conducted clinical 
observations. 

The improvements made in this edition render the work more 
than heretofore better fitted to occupy the place to which it has 
been assigned by the generous estimate of the medical profession. 
I should be singularly wanting in a proper feeling, if, in sending 
forth another issue of the work, I did not experience a grateful 
sense of appreciation for the uniformly kindly reception accorded 
to this and to my other publications. 

Roberts Bartholow. 

Philadelphia, September, 1883. 



PREFACE TO THE FOURTH EDITION. 



Engagements that admitted of no postponement prevented 
the preparation of the fourth edition of this work at an earlier 
period. Meanwhile, the activity prevailing on all sides in the 
study of experimental and practical therapeutics has contributed 
many new and important facts to this expanding science. New 
remedies, studied by the physiological method, are presented to 
us in the fullest detail of their actions, and old ones are exam- 
ined anew in the brilliant light of modern scientific methods. 
Subjected to the strictest physiological tests, remedies are pur- 
sued into the closest recesses of Nature, their powers fully ascer- 
tained, and their uses suggested from the standpoint of their 
physiological actions. The old facts thus receive sifting and re- 
examination, and, with the new, demand recognition and ade- 
quate statement. It follows, that any therapeutical treatise which 
would keep pace with the progress of knowledge must be fre- 
quently renewed, amended, and improved. Appreciating fully the 
necessity for this periodical revision of my treatise, I have care- 
fully reviewed the acquisitions of the period intervening since the 
publication of the last edition, and have in the present edition in- 
corporated those improvements in our therapeutical resources which 
seem to be of permanent value. I have revised the text at all 
points, have rewritten many articles, made important additions to 
others, and have inserted, for the first time, the articles on Ba- 
rium, Nitroglycerin^ Curara, Muscarine, Besorcin, etc. The 
group Antiseptics has been transferred to a more appropriate 
position, among the systemic remedies. The growing importance 
in modern pathology of the germ theory requires this group- 
ing of certain remedies possessing the power to destroy the mi- 



PREFACE TO THE FOURTH EDITION. j x 

nute organisms of disease, and to arrest septic processes. These 
properties are sufficiently distinctive to require their recognition in 
a separate group ; but, in addition, the remedies composing this 
group have antipyretic effects. It has been suggested that the 
antiseptic action is the source of the antipyretic — that in the 
destruction of germs, or morbific ferments, lies the power to 
arrest the excess in heat-production. 

Notwithstanding the numerous and important additions to 
the work, the number of pages has been increased only about 
seventy. In several instances important additions have been 
made, without any increase of space, by the sacrifice of the ref- 
erences. In the rewriting of old articles and in the preparation 
of the new, the utmost conciseness consistent with clearness and 
accuracy has been the ruling principle. True to the idea ex- 
pressed in the first edition, I have, as far as possible, accepted 
the results of physiological research, but have not ignored the 
facts obtained empirically. Unquestionably, the tide of thera- 
peutical knowledge sets strongly in the direction indicated by the 
former, and the latter is as distinctly ebbing outward. On all 
sides the conviction is growing, that the real and permanent 
advances in therapeutical art must be effected chiefly by the 
physiological method. Nevertheless, empirical facts of undoubted 
value are occasionally brought forward. In a the shapeless mass 
of inexact ideas," as Bichat entitled empirical observations, there 
are often found genuine therapeutical gems. 

Besides the careful revision given to the whole work, I have 
rewritten the " Clinical Index," with a view to the addition of 
new matter, and to secure greater accuracy of expression. Pre- 
scriptions which heretofore had a place in this index, and were 
transcribed from the body of the work, have been omitted, as 
their repetition seemed unnecessary, and gave opportunity for 
serious errors. The page reference permits the easy finding of a 
formula, and in the search the context will be read, so that with 
the prescription will be obtained needful explanations. 

In submitting this edition to my professional colleagues, I am 
again afforded the grateful opportunity to express my sincere ap- 
preciation of the favor with which each formal edition has been 



X PREFACE TO THE FOURTH EDITION. 

received. I- must also repeat my acknowledgments to the kind 
correspondents who have informed me of errors, textual and typo- 
graphical, coming under their notice, and I now thank in advance 
any one of my readers who, observing an error of any kind, will 
inform me of it. 

K. B. 

Philadelphia, September 1, 1S81. 



PREFACE TO THE SECOND EDITION. 



The success of my treatise lias exceeded any reasonable ex- 
pectations, and, under the circumstances, is peculiarly gratifying. 
Constructed on a somewhat different plan from the ordinary text- 
books, and brought into direct competition with several very able 
and well-established works on the same subject, I could not but 
feel that its progress to professional favor must necessarily be 
slow. That several considerable editions have been exhausted in 
the first year of its publication, and that the demand for the 
book has not abated, indicate that its appearance was opportune, 
and that its plan and execution are approved by the medical 
profession. 

In this new edition various improvements have been made, 
and articles on the following subjects have been inserted : 



Beverages. 


Heat, 


Digestion-Ferments. 


Vegetable Acids. 


Cadmium. 


Cerium. 


Picrotoxin. 


Cannabis Indica. 


Cuca. 


Caffein. 


Guarana. 


Pulsatilla. 


Grindelia. 


Phytolacca. 


Ailanthus. 



Besides the new articles, additions have been made at various 
points. Notwithstanding these additions, the bulk of the work 
has not been materially increased, and its practical character has 
been strictly maintained. 

Increasing observation satisfies me that an author, writing on 
such a complicated topic as the actions and uses of remedies, 
owes it to his readers to present them the results of his matured 
experience and his most composed judgment, rather than lay be- 
fore them a multitude of opinions, experiments, and reports, out 
of which they must construct, if they can, a consistent theory, 



x ii PREFACE TO THE SECOND EDITION. 

or form an adequate conception of the nature and relations of 
all the facts. But few readers will give the time to so tedious 
a task, and the smallest number are fitted by education, training, 
and habits of mind, for working out results from such a com- 
plicated mass of materials. While every author is bound to in- 
dicate to his readers the sources of his information, it is equally 
his duty to present that information in the form most available 
for immediate use. 

The classification of remedies must continue in an unsatisfac- 
tory state, and any scientific scheme is, at present, hopeless. The 
distinguished and able Prof. Edward H. Clark, M.D., of Har- 
vard (Boston), in his review of this work {The American Jour- 
nal of the Medical Sciences, January 7, 1877), justly remarks as 
follows : 

" No scientific classification of the materia medica is possible in the present 
state of science. Writers are, therefore, justified in adopting any classifica- 
tion that may happen to suit their fancy, or in adopting none at all." 

Notwithstanding a scientific arrangement is unattainable, it is 
certainly convenient to group together those agents which are 
physiologically and therapeutically allied. I have adopted, in part, 
the classification proposed, in 1863, by Dr. Chambers ("Renewal 
of Life," etc.), using the two great divisions of " agents promot- 
ing constructive metamorphosis " and " agents promoting destruc- 
tive metamorphosis." As respects the assignment of individual 
remedies, in accordance with certain conceptions of their powers 
and actions, the arrangement adopted is entirely my own. 

The omission of certain botanical, chemical, and pharmaceuti- 
cal details, except such as are necessary to a just appreciation 
of the physiological actions, or to "facilitate intelligent prescrip- 
tion-writing," has been decidedly commended by the reviewers, 
and by my readers generally. In the present state of pharmacy, 
knowledge of the kind omitted would prove useless, in the main, 
to physicians, even if acquired. I beg, however, to call the at- 
tention of my readers to the fact that the official designation of 
the remedy, its pharmaceutical preparations, its chemical compo- 
sition, and its active principles, are carefully stated, and should 
be mastered by every student. This knowledge of the technik 



PREFACE TO THE SECOND EDITION. xiii 

of his armamentarium is an indispensable requisite to its skill- 
ful use. 

The author has a strong conviction that, in the future of thera- 
peutics, the law or principle of physiological antagonism must 
play an important role. He has indicated more fully, probably, 
than any other systematic writer, the application of this principle 
in practical therapy. 

In the preparation of the articles I have studiously endeavored 
to preserve the harmony and proportion of the parts, and have 
treated them with a fullness and particularity according to their 
relative importance. In this way it may appear to some of my 
readers that I have exaggerated some topics, and have treated 
others, equally important, with indiiference. Having given careful 
consideration to this subject in the course of my preparations for 
the new edition, I conclude that the judgments formed in the first 
instance are confirmed by more extended study and observation. 

Any one discovering an error of any kind in this edition of 
my treatise will place me under great obligations by reporting it 
to me without delay. 

I am indebted to my assistant, Dr. Frederic Kebler, for the 
revision of the indexes. 

Roberts Bartholow. 

120 West Seventh Street, Cincinnati. 



PREFACE TO THE FIRST EDITION. 



To offer to the medical profession a new treatise on Materia 
Medica and Therapeutics may appear to be a labor of supereroga- 
tion. The medical literature of this country is already well pro- 
vided with able and elaborate works on this subject. The learned 
and encyclopedic volumes of Stille, based on the empirical method, 
and the modern and scientific work of H. C. Wood, based on the 
physiological method, leave almost nothing to be desired. Enter- 
taining such a profound respect for the work of my American 
colleagues, it may well be inquired why I have ventured to add a 
new book to those already existing in this department of medical 
knowledge. A belief, which I trust will not be regarded as ego- 
tism, that I have earned the right to address the medical profession, 
has moved me to the preparation of this work. Several years a 
teacher of Materia Medica and Therapeutics, I have necessarily 
formed opinions as to the kind of information which should be 
contained in a treatise on this subject. As far as such a course of 
experiment is practicable, I have demonstrated in my lectures the 
actions of remedies on animals. I have conducted in my private 
laboratory many independent investigations, and have contributed 
in this way, I submit with diffidence, some original knowledge to 
the subject of therapeutics. The information thus acquired has 
been supplemented by twenty-two years of clinical experience as 
a practitioner of medicine. Under these circumstances, I am in- 
duced to believe that my professional brethren, and medical stu- 
dents, will hold that I am entitled to a hearing. 

A volume on Materia Medica and Therapeutics should, in these 
days, present some new features of importance if it would worthily 
occupy a place alongside of the excellent works now accessible to 
American readers. An examination of this treatise will disclose the 
fact that it differs from other works in its scheme of classification, 



PREFACE TO THE FIRST EDITION. xv 

in the subjects discussed, and in the very practical character of the 
information. In the present state of our knowledge, it is impossible 
to make a classification free from defects, and I do not claim for 
mine that it is superior to others — only that its simplicity is a point 
in its favor. As respects the subjects treated of, it will be seen that 
the most elaborate section is that on aliment, and that remedies have 
been introduced not usually referred to by therapeutical writers. 
In the treatment of individual agents, I have, usually, adopted the 
description of the " United States Pharmacopoeia," and have omitted 
botanical and chemical details, unless they are necessary to elucidate 
physiological questions, or to facilitate intelligent prescription-writ- 
ing. All pharmaceutical questions are most thoroughly handled in 
the "Dispensatory" of Wood and Bache, and this kind of knowl- 
edge is more the province of the druggist than of the physician. 

In describing the physiological action of drugs, two methods 
may be pursued : to present in chronological order a summary of 
the opinions of various authorities on the subject in question ; or, 
to condense in a connected description that view of the subject 
which seems to the author most consonant with all the facts. I have 
adopted the latter plan, from a conviction of its advantages for the 
student, and of its utility for the practitioner. The authorities 
which I have utilized in making up my opinions are placed at the 
end of each article, in order to avoid interruptions in the methodical 
descriptions. 

As respects the therapeutical applications of remedies, I have, as 
far as practicable, based them on the physiological actions. Many 
empirical facts are, however, well founded in professional experience. 
Although convinced that the most certain acquisitions to therapeu- 
tical knowledge must come through the physiological method, I am 
equally clear that well-established empirical facts should not be 
omitted, even if they are not explicable by any of the known physi- 
ological properties of the remedies under discussion. 

My best acknowledgments are due to John Chatto, Esq., the 
learned Librarian of the Eoyal College of Surgeons, London, for 
numerous courtesies extended to me during my visits to Lincoln's- 
Inn-Fields. Eobekts Bautholow. 

120 West Seventh Street, ) 

Cincinnati, Ohio, June, 18*76. ) 



A~ 



TABLE OF CONTENTS. 



PAGE 

Schema . . . 1 

PART I. 

Routes by which Medicines are introduced into the Organism . . . . 5 

1. Through the External Integument 5 

2. Through the Internal Integument 6 

3. By the Subcutaneous Areolar Tissue . 15 

4. By the Veins 20 

Transfusion of Blood 22 

Arterial Transfusion . . 25 

Transfusion of Milk .25 

Peritoneal Transfusion 26 

PART II. 

The Actions and Uses of Remedial Agents' 28 

Those used to promote Constructive Metamorphosis 28 

Aliments 28 

Animal . . .30 

Vegetable 40 

Special Plans of Diet . . 44 

Denutrition 44 

Dry Diet 47 

Vegetable Diet 48 

Milk Diet 50 

Infant Feeding .52 

Alimentation in Diseases 56 

Aliment in Acute Inflammations and Fevers 56 

Formulae for Animal Broths 57 

Formulae for Diet Drinks . . . . . ... .57 

Aliment in Diseases of the Digestive Organs 59 

Aliment in Cachectic States 60 

Formulae for Articles of Diet . 61 

Nutrient Enemata . . . . . . . . „ . .62 

Supplementary Rectal Alimentation ....... 63 

Beverages .66 

Coffee 66 

Tea . 66 

Cocoa 66 

Milk . . . . .68 

1 



xviii TABLE OF CONTENTS. 

PAGE 

Water 69 

Aqua 69 

Fluvialis 69 

Fontana 69 

Modes of applying Water 71 

Russian Bath 71 

The Wet Pack 71 

The Douche 73 

The Hip or Sitz Bath 73 

Hydrotherapy 73 

Heat 82 

Modes of applying Heat 83 

Solar Heat 83 

Artificial Heat 83 

Moist Heat 83 

Dry Heat .83 

The Turkish Bath . . .84 

Air 85 

Pure Air 86 

Impure Air 86 

Effects of Compressed Air 88 

Therapy of Compressed Air 90 

Massage 92 

Digestion Ferments 96 

Pepsin 96 

Ingluvin 96 

Pancreatin * 97 

Papaiva or Papain . . . 98 

Acidum Lacticum 101 

Mineral Acids 103 

Oils and Fats 112 

Phosphorus and some of its Compounds 119 

Phosphites and Phosphates . 128 

Iron and its Preparations 132 

Manganum — Manganesium 145 

Chalybeate Mineral Springs 149 

Bismuth 151 

Arsenic 154 

The Simple Bitters 167 

Aromatic Bitters 171 

Oleum Erigerontis 172 

Eucalyptus 174 

Hydrastis 177 

Cinchona and its Preparations 180 

Agents promoting Destructive Metamorphosis or increasing Waste . . . 200 

Alkalies 200 

Potassium and its Preparations 200 

Sodium and its Preparations 208 

Calcium and its Preparations 210 

Lithium and its Preparations 212 

Alkaline Mineral Springs . . ,216 

Saline Mineral Springs „ „ .219 



TABLE OF CONTENTS. xlx 

PAGE 

Ammonium and its Preparations . . . . „ „ . .223 

Barium and its Preparations 229 

Vegetable Acids . . * .' • . 232 

Sulphurous Acid and the Sulphites 23-4 

Sulphur and Sulphides (Sulphurets) 236 

Sulphurous Mineral Waters 238 

Iodine and its Preparations „ .241 

Ether Hydriodicus 253 

Iodoform 254 

Iodol 260 

Mercury and its Preparations 262 

Aurum (Gold) and its Preparations 279 

Argentum (Silver) and its Preparations .281 

Cuprum (Copper) and its Preparations ........ 289 

Plumbum (Lead) and its Preparations . 293 

Zincum (Zinc) and its Preparations 299 

Antimonium (Antimony) and its Preparations 304 

Cadmium Sulphate 308 

Cerium Oxalate 309 

Metallotherapy 310 

Alumen (Alum) and its Preparations . . 313 

Acidum Tannicum 317 

Acidum Gallicum 317 

Galla (Nutgall) 317 

Catechu 317 

Kino 318 

Krameria (Rhatany) 318 

Haematoxylon (Logwood) 318 

Geranium (Cranesbill) 318 

Quercus Alba (White Oak) 318 

Quercus Tinctoria (Black Oak) . . .■ 318 

Rosa Gallica (Red Rose) . . 319 

Rubus (Blackberry) . . . 319 

Myrica Cerifera (Bayberry) . . . 319 

Alnus Serrulata (Alder) 319 

Statice Limonium (Marsh Rosemary) 319 

Heuchera (Alum-Root) 319 

Hamamelis Virginica (Witch-Hazel) 319 

Nymphsea Odorata 320 

Castanea Vesca 320 

Colchicum and its Preparations 327 

Sarsaparilla and its Preparations 330 

Guaiacum and its Preparations 332 

Stillingia and its Preparations 333 

Sanguinaria (Blood-Root) 335 

Xanthoxylum . .338 

Fraxinus Americana 339 

Remedies used to destroy Microbes, or Morbific Germs, and to prevent or arrest Sep- 
tic Processes (Antiseptics or Germicides) 340 

Antiseptics 340 

Oxygen 341 

Ozone 342 



xx TABLE OF CONTENTS. 

PAGE 

Chlorine 343 

Bromine 345 

Trichlorphenol 330 

Gaseous Enemata and Inhalations 346 

Carbolic Acid 348 

Creosote 349 

Sulphoearbolates 359 

Salix .361 

Salicin 361 

Salicylic Acid 362 

Phenol and Chinoline Derivatives 373 

Resorcin 3*73 

Phenoresorcin 376 

Hydroquinone and Pyrocatechin 376 

Kairin and Kairolin 376 

Chinoline 377 

Salol 378 

Antipyrine ............. 381 

Naphthalan 384 

Naphthol 385 

Pyridine 386 

Pyridine Tricarboxylic Acid . . . 386 

Saccharin 387 

Boracic Acid 387 

Benzoin 389 

Benzoates 390 

Acetanilide 392 

Antiseptic Oils 395 

Gaultheria 395 

Thyme 395 

Cajeput 395 

Thymol 395 

Myrtol ..... 396 

Agents used to modify the Functions of Organs 397 

A. Of the Nervous System 397 

Those exciting the Functional Activity of the Spinal Cord and Sympathetic . 398 

Electricity 398 

Static Electricity 398 

Magnetism 400 

Galvanism 401 

Faradism 408 

Galvano-Faradization 411 

Electric Baths 412 

Electro-Physiology 412 

Electro-Diagnosis 416 

Therapy 419 

Electrolysis 428 

Galvano-Cautery 429 

Static Electricity 430 

Trouve's Polyscope 430 

Nux Vomica and its Preparations 431 

Strychnine 432 



TABLE OF CONTENTS. xxi 

PAGE 

Ignatia 444 

Cocculus 444 

Picrotoxin 445 

Ergota (Ergot) and its Preparations ......... 448 

Ustilago Maydis (Corn-Ergot) 461 

Digitalis and its Preparations 462 

Convallaria 470 

Strophantus 473 

Sparteine 474 

Adonidin 475 

Cimicifuga and its Preparations 476 

Belladonna and its Preparations 479 

Atropine 479 

Homotropine 490 

Stramonium and its Preparations 491 

Hyoscyamus and its Preparations 492 

Hyoscine 495 

Duboisia 497 

B. Agents exciting the Functional Activity of the Cerebrum .... 499 

Camphor and its Preparations . . . 499 

Asafoetida and its Preparations . . . . . . . . . 503 

Ammoniacum and its Preparations . . . . . ... . 506 

Valeria* and its Preparations . . .- . . . . . . 506 

Cannabis Indica 508 

Cannabis Americana 508 

Erythroxylon 511 

Caffeine 516 

Guarana 520 

Remedies which diminish or suspend the Functions of the Cerebrum after a Pre- 
liminary Stage of Excitement 521 

Alcohol 521 

Vinum (Wine) 531 

Beer, Ale, and Porter 53d 

Extract of Malt 537 

Paraldehyde 537 

Methylal 538 

Chloride of Methyl 539 

Urethan 539 

Hypnone 541 

JEther .542 

Chloroformum ............. 546 

Chlorodyne 549 

Anaesthetics and Anaesthesia 550 

Ether and Chloroform 550 

Ethyl Bromide . 559 

Bichloride of Methylene 560 

Local Anaesthesia 561 

Nitrous Oxide 562 

Chloral 564 

Croton Chloral Hydrate 570 

Opium and its Preparations 571 

Morphine and its Salts 573 



xx ii TABLE OF CONTENTS. 

PAGE 

Humulus (Hops) 592 

Lupuline 592 

Laetueariuni . . 593 

Bromides .............. 593 

Agents which depress the Motor Functions of the Spinal Cord and Sympathetic . 605 

Conium and its Preparations 605 

Conine and Morphine . 609 

Coram or Woorara 610 

Curarine 610 

Gelsemium and its Preparations 614 

Arnica and its Preparations 619 

Trimethvlamine 620 

Pilocarpus 622 

Physostigina and its Preparations 629 

Tabacum (Tobacco) and its Preparations 635 

Lobelia and its Preparations 639 

Acidum Hydrocyanicum 641 

Potassii Cyanidum 645 

Amyl Nitrite 647 

Nitro-glycerin 650 

Aconite and its Preparations 654 

Veratrum Viride and its Preparations 659 

Pulsatilla and its Preparations 664 

Grindelia and its Preparations 665 

Phytolacca and its Preparations .667 

Ailanthus 668 

Agaricin 669 

Muscarine • 669 

Quebracho 673 

Remedies used to modify the Functions of Organs (continued) .... 676 

B. Of the Gastro-intestinal Canal 676 

Emetics 676 

Emetics by Local Action 676 

Systemic Emetics 678 

Apomorphine ........... 678 

Ipecacuanha and its Preparations 6S0 

Cathartics 686 

Laxatives 686 

Manna 686 

Sulphur 687 

Pulvis Glycyrrhizse Compositus 687 

Magnesia 687 

FelBovis 6S8 

" " Purif. . 689 

" " Inspissatum 6S9 

Cascara 689 

Oleum Pacini 689 

Saline Purgatives 691 

Sulphate of Magnesia 691 

Mercurial Purgatives 694 

Calomel 694 

Massa Hydrargyri 694 



TABLE OF CONTENTS. xx iii 

PAGE 

Tonic-Astringent and Resin-bearing Purgatives 695 

Senna and its Preparations 695 

Rheum and its Preparations 696 

Aloes and its Preparations 698 

Jalap and its Preparations . . . . • 701 

Scammony and its Resin 702 

Colocynth and its Preparations 7o2 

Podophyllum and its Preparations 703 

Leptandra • 704 

Iris 705 

Euonymus 705 

Baptisia 706 

Hydragogue Cathartics . . . . 706 

Gamboge 706 

Croton-Oil 707 

Elaterium 709 

Elaterin 709 

Enemata 710 

Anthelmintics 712 

For Ascarides 713 

Mucuna : 713 

Santonica ■ . 713 

Santonin . . 713 

Spigelia and its Preparations 715 

Chenopodium 715 

Oleum Chenopodii 715 

For Taeniae 716 

Filix Mas (Male Fern) 716 

Oleo-resina Filicis 716 

Granati Fructus Cortex 716 

Brayera 717 

Kamala 717 

Pepo (Pumpkin-Seeds) 717 

Uri no-Genital Remedies 718 

Terebinthina 718 

Oleum Terebinthinae _ 718 

Terebinthene 723 

Terpine 723 

Terpinol 723 

Terebene 723 

Copaiba and its Preparations 725 

Cubeb and its Preparations 727 

Piper 728 

Oleo-resina Piperis . . . . . 728 

Capsicum and its Preparations 729 

Juniper and its Preparations 730 

Erigeron 731 

Oleum Erigerontis 731 

Buchu and its Preparations 732 

Uva Ursi and its Preparations 732 

Pareira and its Preparations . . . . . . . . . .732 

Chimaphila and its Preparations 732 



xxiy TABLE OF CONTEXTS. 

PAGE 

Scoparius . 732 

Carota 733 

Taraxacum and its Preparations 733 

Seilla and its Preparations 734 

Petroselinum 736 

Polygonum Hydropiperoides 737 

Ruta .737 

Sabina 738 

Cantharis 739 



PART III. 

Topical Remedies 742 

Theory of Counter-Irritation 742 

Counter-irritants 744 

Rubefacients 744 

Sinapis Alba 744 

Sinapis Nigra 744 

Charta Sinapis . 744 

Emplastra 745 

Linimenta ' 745 

Epispastics 745 

Ceratum Cantharidis . 746 

Ceratum Extract! Cantharidis 746 

Charta Cantharidis 746 

Collodium cum Cantharide 746 

Linimentum Cantharidis 746 

Acupuncture 749 

Baunscheidtismus 749 

Aquapuncture 750 

Jequirety 751 

Bloodletting 753 

Escharotics 756 

Acidum Chromicum 756 

Emollients, Protectives, and Demulcents 757 

Glycerin and its Preparations 757 

Collodium 759 

Liquor Gutta-Perchae 760 

Chondrus (Irish Moss) 760 

Cetraria (Iceland Moss) 760 

Acacia and its Preparations 761 

Tragacanth 761 

Mucilago Tragacanthae . . 761 

Sassafras Medullae 761 

Mucilago Sassafras Medullae 761 

Linum (Flaxseed) and its Preparations 761 

Ulmus (Slippery Elm) 761 

Mucilago Ulmi 761 

Glycyrrhiza and its Preparations 762 

Poultices 762 



A TEEATISE 



MATERIA MEDICA AND THERAPEUTICS. 



SCHEMA. 

Paet I. — Modes in ichich Medicines are introduced into the Or- 
ganism. 

Part II. — The Actions and Uses of Remedial Agents. 
I. Systemic Remedies : 

1. Those used to promote the constructive tissue metamorphosis 
(Tonics). 

2. Those used to increase the retrograde tissue metamorphosis 
(Alteratives). 

3. Those used to destroy micro-organisms or morbific germs, and 
to prevent or arrest septic processes (Antiseptics). 

4. Those used to modify the functions of organs : 

A. Of the Nervous System : 

Increasing Action, 
Diminishing Action. 

B. Of the Gastro-Intestinal Canal : 

Emetics, 

Cathartics, 

Anthelmintics. 

C. Of the Genito-Urinary Organs : 

Diuretics, 

Emmenagogues, etc. 
II. Topical Remedies : 
Rubefacients, 
Epispastics, 
Eschar otics, etc. 
2 



o SCHEMA. 

In this scheme the medicament is followed from its introduction 
into the stomach to its elimination by the organs of excretion. One 
group of remedies is used for an action on the primary assimilation — 
to promote digestion and absorption — the first step in the great pro- 
cess of blood-making. Of this kind are pepsin, the bitters, but, above 
all, foods. 

Some remedies are employed both to increase the activity of the 
primary assimilation and the utilization of materials in the construc- 
tion of tissues ; others, to hasten the retrograde metamorphosis, or the 
processes of waste and excretion. The action of iron furnishes a typi- 
cal example of the one, and mercury of the other mode of influencing 
the function of assimilation. 

An important group of remedial agents is constituted of those 
having the power to act on — to inhibit or destroy — pathogenic organ- 
isms, and to prevent or arrest septic processes. As these remedies 
are also antipyretic, there is supposed to be a relation between this 
attribute and the germ-destroying and antiseptic powers. As sub- 
stances having the chemical reactions and toxic activity of alkaloids, 
and known as ptomaines, are produced by septic decomposition in 
the intestinal canal under certain conditions, and as similar agents 
are developed in the organism in the course of infectious diseases, 
remedies possessed of such powers must necessarily occupy an impor- 
tant place in therapeutics. 

Besides the foregoing, there are several groups of remedial agents, 
that are used not to affect metamorphosis of tissue in any manner, 
but to modify the functions of organs. As the most influential and 
widely connected are the functions of the nervous system, the reme- 
dies affecting them are appropriately considered first. They may be 
conveniently grouped in two classes : those that exalt, those that de- 
press function — as excito-motor, depresso-motor. Of these, strych- 
nine is a type of the former, conium of the latter. 

Other functions are affected by remedies in several modes : by 
coming in contact with the anatomical elements of organs engaged 
in their elimination, or being so irritant as to excite action for 
their expulsion. The diuretics, for the most part, illustrate the for- 
mer mode of action, and some emetics and purgatives the latter. 
The actions cease with the expulsion or elimination of the offending 
matters. 

Remedies that are truly topical should make a local impression 



SCHEMA. 3 

only, but it is probable that no action can be confined to the part 
acted on. Absorption is not necessary to, and indeed hinders, the 
local effect ; hence the systemic impression made by them is accom- 
plished through the agency of the nervous system. Some of the most 
important of their therapeutical effects are due to the influence of the 
peripheral excitation on the nervous centers in anatomical connection 
with the part irritated. A superficial neuritis may excite extensive 
secondary lesions in the spinal cord. The vaso - motor and trophic 
systems are peculiarly impressionable to peripheric irritation, and 
hence, through the intermediation of this nervous apparatus, impor- 
tant changes may be wrought by slight counter-irritation. 



PAET I. 

R UTES B T WHICH MEDICINES ARE INTR OB UCEB 
INTO THE ORGANISM, 



I. 

THROUGH THE EXTERNAL INTEGUMENT. 

By this tissue medicines are applied in the following modes : 

Enepidermatic. 

Epidermatic. 

Endermatic. 

Enepidekmatic. — In this method, the medicament is placed in 
contact, only, with the epidermis, and friction, to hasten absorption, is 
not employed. Although the epidermis opposes a strong obstacle to 
absorption, it does not entirely prevent diffusion into the blood, as 
numerous facts show. The skin may be considered a colloidal sep- 
tum. The rate and degree of absorption of any medicine will depend, 
in large part, on its power of diffusion. Various circumstances influ- 
ence this — for example, the chemical position of the agent to be dif- 
fused. On one side of the colloidal septum — the skin — lie the blood- 
vessels, containing an alkaline fluid. An acid fluid on one side of the 
dialysing membrane, and an alkaline fluid on the other, are conditions 
most favorable to diffusion. Experiments are wanting on this point, 
but it is a reasonable presumption that solutions of medicinal sub- 
stances, acid in reaction, will find their way most readily into the 
blood. 

Besides the epidermis, the sebaceous matter of the skin offers more 
or less positive obstruction to cutaneous absorption. Medicinal sub- 
stances in solution in water, therefore, very slowly permeate the skin 
to enter the vessels. Waller, who has made very careful experiments, 
has ascertained that alkaloids dissolved in chloroform are readily trans- 
ferred through the skin into the blood, and produce characteristic phe- 
nomena, while " alcoholic and aqueous solutions are either not at all, or 
very slowly, absorbed." 



6 HOW MEDICINES ARE INTRODUCED. 

His observations were made with chloroformic solutions of aconi- 
tine, atropine, strychnine, and morphine. Waller further ascertained 
that alcohol mixed with chloroform did not retard absorption, but al- 
cohol alone caused an outward osmotic flow. It follows from these 
facts that, if, in the application of a medicinal agent to the skin by the 
endermatic method, the object be to promote absorption, the remedy 
should be dissolved in chloroform, or in a mixture of alcohol and chlo- 
roform, and not in alcohol alone, or in water. 

Epidermatic. — This method differs from the enepidermatic in that 
friction is employed to promote absorption by forcing the medicament 
between the cells of the epidermatic layer. Many agents are used in 
this way, as mercurial ointment in syphilis, cod-liver oil, and other 
fats, in wasting diseases, and ointments of various kinds for the relief 
of local lesions, etc. The evidence is conclusive that by this mode 
systemic effects are produced. 

Endermatic. — As the epidermis is the chief obstacle to cutaneous 
absorption, it is sometimes removed by blistering, so that the medica- 
ment may come into immediate contact with the derma. The mode 
of proceeding by the endermatic method is as follows : a piece of flan- 
nel, patent lint, or cotton cloth, is moistened with aqua ammonice, and 
when placed on the skin is covered with oiled silk to prevent evapora- 
tion. When the blister is raised, the epidermis is removed with scis- 
sors. A less painful, but slower method, is the application of a can- 
tharides-plaster, followed by a poultice to raise the blister. The 
medicinal agent, in a finely-powdered state, is sprinkled over the raw 
surface, and is rapidly absorbed. Morphine, atropine, strychnine, and 
quinine, are the most important agents used in this way. 

The endermatic method is a useful resource to the therapeutist, 
but the opinion of Brown-Sequard is hardly admissible, that the exten- 
sive use of the hypodermatic method has caused the endermatic to be 
unwisely neglected. There are decided objections to the endermatic 
method : it is painful ; absorption is somewhat uncertain ; ulceration 
of an intractable character may occur. It has these advantages in its 
favor : it may be used in cases of irritable stomach ; it may be con- 
joined with counter-irritation ; it is sometimes quite effective. 

II. 

THROUGH THE INTERNAL INTEGUMENT. 

Applications to the Broncho-pulhonary Mucous Meji- 
beane. — By the method of insufflation solid medicinal agents in 
a finely-divided state are applied to various parts of the respiratory- 
tract. Insufflation-tubes with a rubber air-bag attached are now 
found at the instrument-makers. The powder, contained in a chamber 
intended for its reception, is forced by the compression of the air-bag 



BY THE BRONCHO-PULMONARY MUCOUS MEMBRANE. 7 

through the straight or curved delivery-tube of the instrument. Pow- 
ders may be projected by such an apparatus into fauces, larynx, and 
anterior and posterior nares. In the absence of an insufflator, a sim- 
ple glass tube or goose-quill may be used for the purpose — the powder 
being blown in by the operator, or drawn in by a forcible inspiration 
by the patient. 

The method of insufflation is a useful mode of making local appli- 
cations to the nares, fauces, epiglottis, and the aryteno-epiglottidean 
folds, but it is of little utility as a means of reaching the larynx and 
trachea, for, as is well known, the glottis is exceedingly intolerant of 
foreign bodies whether solid or gaseous. By this method we can use 
tannin, the zinc salts, nitrate of silver, alum, morphine, etc. Any 
remedy thus applied should be in small quantity, should be minutely 
subdivided and mixed with some unirritating, impalpable powder, so 
as to insure uniform distribution over the, surface to be acted upon. 

The nasal douche is a mode of applying remedies to the nasal pas- 
sages now much practiced. This consists of a bottle or funnel-shaped 
reservoir to contain the medicated fluid, and a flexible rubber tube to 
which is attached a hard-rubber or glass nose-piece. The reservoir be- 
ing placed on a higher level than the head, the nose-piece adjusted 
and the mouth being kept open, the fluid is permitted to flow. As when 
the mouth is open, the patient breathing quietly, the palate applies 
itself closely to the posterior wall of the pharynx, it is obvious that the 
fluid will be conducted from the one to the other nostril and thus make 
its exit. Not every patient can succeed perfectly in the performance 
of this feat. In some persons, even when breathing quietly through 
the open mouth, the veil of the palate does not apply itself perfectly 
to the posterior fauces and the fluid flows into the oesophagus. Other 
persons can not refrain from attempts at swallowing when the fluid 
reaches the posterior nares. It happens not infrequently that the 
fluid, or the insufflation powder, gets into the Eustachian tube and 
middle ear, so that pain and inflammation follow with impaired hear- 
ing, and sometimes cause destructive inflammation and suppuration. 
If pain in the ears follows its use, it is quite certain that mischief 
will result if the douche be persisted in. The following rules should 
be adhered to in making applications by this method : 

The fluid used must be tepid. 

The first applications must be bland and unirritating. 

The applications, if strong enough to excite irritation, must not be 
used frequently. 

Under the most favorable circumstances this mode of treating dis- 
eases of the nasal passages has very limited utility, for the fluid 
reaches but a part of the Schneiderian mucous membrane. It is a 
useful means for cleansing the nares, and for applying deodorizing 
agents to correct fetor. Chlorides of sodium, potassium, and am- 



8 HOW MEDICINES ARE INTRODUCED. 

nionium, permanganate of potassa, carbolic acid, iodine, and many- 
other agents of the same kind, are applied by means of the nasal 
douche. 

An ordinary Davidson's syringe, made to act as a siphon, may be 
used in the same way as the Weber's or Thudichum's nasal douche. 
The mode of proceeding with this instrument is as follows : the vessel 
containing the medicated fluid is placed on a higher level than the 
patient's head ; the syringe is filled by compressing the bulb to expel 
the air, and then inserting the suction-pipe in the fluid ; the nozzle of 
the delivery-pipe is put into the nose, when a steady stream will dis- 
charge into the nostril and escape by the other. 

Inhalations. — Vapors of medicinal substances, and gases, are con- 
ducted with the air into the bronchial tubes and the air-sacs. Yapor 
of creosote, carbolic acid, iodine, ethyl iodide, iodoform, bromine, etc., 
are thus employed with excellent effect. Those that require heat to 
be vaporized can be put in a warm vial or bottle, and the vapor then 
conducted to the nose or mouth by a cone of stiff paper, the base of 
the cone being large enough to cover the vessel in which the vapor 
is forming. Of the compounds of iodine, the most convenient and 
effective for inhalation is ethyl iodide. It requires no special con- 
trivance, and does not have an anaesthetic effect that will narcotize. 
The warmth of the hand is sufficient to vaporize it, and hence it may 
be inspired from the vessel containing it. A few drops (ten to thirty) 
may be put on a folded napkin or handkerchief and inhaled, or the 
same quantity can be dropped in a vial previously warmed, and im- 
mediately inhaled. Ethyl-iodide vapor can be readily mixed with a 
proper proportion of nitrous oxide, or combined with the vapor of 
iodine, iodoform, creosote, carbolic acid, and with other antiseptics. 
Whatever difficulties are encountered are merely mechanical. In a 
recent issue of the "iEsclepiad" (1886), Dr. B. W. Richardson, of 
London, calls attention to the remarkable powers of ozonic ether as 
a remedy in pulmonary diseases — a recommendation which he holds 
is the most valuable he has ever contributed to practical medicine. 
His mode of procedure is described in the article referred to, and an 
abstract may be found in the " New York Medical Journal " of 
March 13, 1887. 

Pyridin vapor has been brought out by Professor See, as an in- 
halant of remarkable efficacy in asthma and other neuroses of the 
respiratory apparatus. The air of an apartment of suitable size can 
be made by diffusion to contain a proper amount of pyridin vapor. 
As persons vary in susceptibility to the action of such a vapor, the 
necessary quantity must be ascertained by trial. Various permanent 
gases are now used by inhalation, in diseases of the respiratory mucous 
tract. An improvement warmly received, yet already waning, is the 
rectal injection of sulph-hydric and carbonic-acid gases. Bernard 



ATOMIZATION OR PULVERIZATION. 9 

having shown, experimentally, that these gases when introduced 
into the rectum, escaped by the lungs without penetrating to the 
nervous centres, Bergeon, of Lyons, utilized this fact, and in this 
way proposed to act on the bacilli of tuberculosis of the lungs. 
The method was received with extraordinary favor, and in a few 
weeks was employed in all parts of the world. It was presently as- 
certained, however, that the bacilli were not destroyed, and the bene- 
fits derived did not compensate for the disagreeable incidents of the 
injections. 

The suggestion of Dupont that the inhalation of the carbonic-acid 
gas should take the place of the rectal injection of the gases, and the 
growing belief in the superiority of inhalations, have quite occupied 
the field, and hence the rectal injections are no longer practiced. 
Prolonged inhalation of volatile materials is a mode rapidly growing 
in favor, and is supplanting douches, insufflation, and other kinds 
of topical applications. As air is a natural vehicle for access to the 
lungs, and as gases and volatile substances can pass into the air-sacs 
by means of it, the method of introducing medicaments by respiration 
is naturally superior to the various mechanical contrivances. Volatile 
medicines capable of diffusion through the air, and gases, may be thus 
used with success. The most powerful of these preparations is the 
liquid of the French chemist, Pictet. The sulphurous and carbonic- 
acid gases are liquefied by pressure and stored up in siphon bottles, 
from which they are readily obtained by a mere touch on the valve. 
It is obvious that such an arrangement is highly convenient, but the 
power for mischief must not be overlooked in estimating the curative 
value. 

Atomization or Pulverization. — Air or steam is the motive power 
in the various forms of apparatus used for reducing solutions of me- 
dicinal agents into spray. Of those now in use, the hand-ball ap- 
paratus for air, and Siegel's apparatus for steam, are the principal. 
Whether air or steam be used for pulverizing the medicated fluid, the 
essential parts of an atomizing apparatus consist of a cup for contain- 
ing the solution to be pulverized, a vertical tube terminating in a fine 
capillary extremity and dipping into the medicine-cup, and a tube 
communicating with the steam-boiler or air-bulb, and placed at right 
angles to the vertical tube. When air or steam is forced through the 
horizontal tube, over the capillary orifice of the vertical tube, the air 
in the latter is rarefied and the fluid rises into it, until, reaching the 
top of the tube, it is broken up into fine spray by the impact of the 
horizontal column of air. It is obvious that, provided with suitable 
tubes, spray may be applied to the nares, anterior and posterior, to 
the pharynx, epiglottis, and larynx. The utility of applications made 
in this way to these parts is now conclusively established. Although 
it has been a question whether any quantity of medicated spray passes 



10 HOW MEDICINES ARE INTRODUCED. 

the chink of the glottis, it has been proved experimentally that a mi- 
nute quantity does actually enter the trachea. The efficacy of inhala- 
tions of subsulphate of iron in pulmonary haemorrhage is a clinical fact 
confirmatory of the experimental demonstrations. The inhalations of 
substances in a state of vapor, and atomized, in affections of the parts 
beyond the larynx, have thus far been rather disappointing, except, 
it may be, the treatment of pulmonary haemorrhage by iron inhala- 
tions. 

In using these topical remedies, some precautions must be taken to 
avoid harm. Strong applications should not be made in the begin- 
ning of the treatment. The mucous membranes should be accustomed 
to the impact of such unirritating substances as warm water and tepid 
solutions of common salt and chloride of ammonium, before commenc- 
ing the use of tannin, the zinc, copper, and silver salts, etc. For 
cleansing the mucous membrane and removing fetor, common salt, 
carbolic acid, iodine, and the sulphides are useful, and as astringents 
and deodorizers, the sulpho-carbolates of zinc, soda, tannin, etc. One 
of the more effective applications for the cure of diseased states is nitrate 
of silver, but it should be kept in mind, in using this agent, that the 
handkerchiefs and linen of the patient will be soiled. Solutions of 
nitrate of silver are best applied by means of the hand-ball atomizer, 
tubes of various shapes, according to the locality, being inserted into 
the anterior and posterior nares, pharynx, or glottis, as the case may 
be. Should the steam atomizer be used for making application of the 
various salts named above, the face of the patient should be protected 
by a shield. 

As iodoform is so offensive because of its diffusive and persistent 
odor, it is now being supplanted by iodol, which is odorless, and at the 
same time, containing as it does as much iodine nearly, has proved to 
be quite as effective. In using the method of insufflation with iodol, 
combinations of the same agents can be made with it as with iodo- 
form. Dr. J. Solis-Cohen, a laryngologist of great eminence, main- 
tains that the combinations of these iodine preparations with tannin 
are more efficient in the treatment of the various morbid states than any 
other. The nature of the curative action, in large part, consists in the 
detention of the iodol or iodoform on the seat of disease, for the tan- 
nic acid combines with the mucus, and thus holds the medicament in 
contact with the affected surface. 

Application to the Gastro-Intestinal Mucous Membrane. — 
The stomach is the organ most usually selected for procuring absorp- 
tion of remedial agents. Diffusion through the walls of the stomach 
into the blood is by no means definite in rate, or in the quantity passed 
even with the same medicament and in the same individual. The 
presence of fluid or food, the chemical reactions which may ensue, the 
state of the mucous membrane, the blood-pressure in the veins, and the 



BY THE GASTRO-INTESTINAL MUCOUS MEMBRANE. H 

condition of annexed organs, are circumstances modifying the rate and 
degree of absorption. The stomach empty, the mucous membrane in a 
healthy state, veins not turgid, are the conditions most favorable for 
rapid and perfect absorption. Crystalloidal substances in solution, 
which pass by simple osmosis into the vessels, are taken up more rap- 
idly and perfectly than colloidal substances which require preliminary 
digestion and solution. It follows, therefore, that medicines in solu- 
tions not intended for a merely local action on the stomach mucous 
membrane, and not irritant in character, as salines, alkaloids, etc., 
should be administered when the stomach is empty. Substances that 
are irritant, or that require digestion and solution, or that, like iron, are 
intended to supply a material to the blood in which it is deficient, are 
best administered during the process of digestion. On the other hand, 
many of the metallic salts precipitate pepsin and thus derange diges- 
tion, whence it follows that they should not be given after food, if un- 
impaired digestion be essential to the safety of the patient. 

Although it is true that medicines in solution are more readily 
taken up than solids, yet many of the latter are absorbed with great 
facility, as metallic iron, calomel, etc., which are rendered soluble by 
the gastric fluids. The chemical changes induced in medicines by the 
gastric juice are by no means well understood. How individual 
agents are affected is a subject to be considered hereafter. 

The following are the chief forms in which medicines are adminis- 
tered by the stomach : 

Powders are medicines reduced by mechanical subdivision, or by 
precipitation, to various degrees of fineness. The Pharmacopoeia of 
1880 advises several grades ; a very fine powder is one triturated to 
that degree that it should pass through a sieve having eighty or more 
meshes to the linear inch ; a fine powder is one which should pass 
through a sieve having sixty meshes to the linear inch ; a moderately 
fine powder is one which should pass through fifty meshes ; a moder- 
ately coarse powder through one having forty meshes, and a coarse 
powder through one having twenty meshes to the linear inch. These 
powders are designated respectively No. 80, No. 60, No. 50, No. 40 and 
No. 20. Those soluble in water are usually administered in that men- 
struum. If insoluble, they may be suspended in water by means of 
sugar, sirup, solution of gum, glycerin, or they may be rubbed up 
with some innocuous powder, as sugar, sugar of milk, liquorice-pow- 
der, etc. 

Triturationes are made by triturating 10 parts of the drug with 
90 parts of sugar of milk. 

Pills are small masses of medicine made into a globular shape, 
by means of an extract, conserve of roses, sirup, or glycerin. A pill 
should not exceed five grains in weight, including the excipient, and, 
as a rule, it should be smaller than this. To cover the taste, pills may 



12 HOW MEDICINES ARE INTRODUCED. 

be coated with sugar, guru, gelatin, silver or gold foil. It should not 
be overlooked that pills too long kept, especially when sugar-coated, be- 
come very hard and insoluble, and therefore without activity. Extem- 
poraneously, pills may be covered with fine tissue-paper, or enveloped 
in a raisin, to cover the taste of the ingredients. 

A Mixture is a suspension of one or more insoluble substances in 
the vehicle, by means of sugar, gum, glycerin, treacle, albumen, etc. 
The term emulsion is restricted in application to the mixture of oil 
and water, in which the oily particles are suspended mechanically by 
rubbing them up with water and gum. 

Extracts are solid and fluid. The solid extract may be aqueous 
or alcoholic ; in the one case water, in the other alcohol, being the 
menstruum employed to extract the active and soluble principles. An 
extract is solid when evaporation is carried far enough to produce a 
soft paste or a dry mass ; it is fluid when sufficient alcohol and water 
are retained to give the proper fluidity. The strength of the fluid 
extract (Pharmacopoeia, 1880) is as follows : " One hundred avoirdu- 
pois ounces of drug make ninety-six fluid ounces," or nearly one minim 
to one grain. The strength of the fluid extract prepared according 
to the Pharmacopoeia of 1870 is five per cent greater. 

Abstracta are dry, powdered extracts, having about twice the 
strength of the official fluid extract. The mode of preparation is as 
follows : An alcoholic tincture is first prepared, the alcohol is then 
evaporated, and the residue is thoroughly triturated with sugar of 
milk. 

Infusions are such solutions of active and soluble principles as can 
be extracted by digesting the crude drug in water, cold or at a tem- 
perature short of boiling. When water at the boiling temperature is 
used, the resulting solution is termed a decoction. Cold infusions are, 
when practicable, to be preferred to decoctions, for, at the tempera- 
ture of boiling water, many active principles are decomposed or vola- 
tilized. 

Infusa are prepared by taking 10 parts of the drug coarsely com- 
minuted, and 100 parts of boiling water, which is poured on ; allowed 
to stand for two hours in a suitable covered vessel, and is then strained, 
and sufficient cold water is added to make 100 parts. 

Decocta are prepared of the same strength as infusions — 10 parts 
to 100 — but the medicament, coarsely powdered, is put into 100 parts 
of cold water, and boiled for fifteen minutes. It is then allowed to 
cool to 113° Fahr., when sufficient cold water is added to make 100 
parts. 

Aceta consist of 10 parts of drug to 100 parts of diluted acetic 
acid. Acidum aceticum dilutum consists of 17 parts of acid and 83 
parts of water, and therefore contains six per cent of absolute acetic acid. 

Vina are preparations made with vinum album fortius, but differ 



BY THE GASTRO-INTESTINAL MUCOUS MEMBRANE. 13 

in strength. The official vinum album fortius is prepared by adding 1 
part of alcohol to 7 parts of white wine. 

Capsules are hollow cylinders or cones of gelatin, to contain offen- 
sively-tasting substances, as copaiba, oil of sandal-wood, etc. In the 
stomach the gelatin is dissolved and the medicament liberated. 

Lozenges or Troches, button-shaped masses, are sometimes intro- 
duced into the stomach, but usually these bodies are intended to 
be dissolved slowly in the mouth, to exert a local action on the 
fauces. 

Wafers are circular disks with a central cavity for holding the 
medicine. They are made of isinglass or of gelatine. 

A Suppository is a conical mass of cacao-butter, or wax and cacao- 
butter, with which is incorporated a medicament, and should not weigh 
more than fifteen grains. They are applied to the rectum, vagina, 
urethra, nares, ear, and other parts. 

Clyster, Enema, Lavement, are medicated solutions to be thrown 
into the rectum. 

Although the rectum as an absorbing surface is inferior to the stom- 
ach, medicines are frequently introduced by this organ with great ad- 
vantage. Some medicines enter the blood more quickly by the rectum 
than by the stomach, but, as a general rule, absorption is slower by the 
former organ. If the mucous membrane of the rectum be irritable, or 
if the substances introduced be irritating or bulky, they will not be re- 
tained. As the contents of the rectum are alkaline, solids requiring an 
acid for their solution will be slowly or not at all taken up. Acid so- 
lutions of medicinal agents, on the other hand, are readily enough ab- 
sorbed, provided the quantity of acid present be sufficient to maintain 
solution. As a general rule the mineral salts act chiefly locally on the 
mucous membrane of the rectum, and enter the blood in small quan- 
tity. The salts of the alkaloids, on the other hand, are absorbed with 
facility. Alkaloids insoluble unless in presence of an acid are not ab- 
sorbed with the same rapidity and completeness by the rectum as by 
the stomach, unless they are administered in acid solution. The salts of 
morphine, atropine, and strychnine, in solution, are absorbed as quickly, 
and the last named more quickly by the rectum than by the stomach. 

Remedies administered by the rectum may be in solution suspended 
in some menstruum, or incorporated with a soap or fat in the form of 
suppository. The solution used should have the temperature of the 
rectum (about 100° Fahr.). The quantity administered should not 
exceed two fluid-ounces of solution. Before introducing a medicated 
solution or clyster into the rectum, this organ should be emptied of 
fecal matter by an ordinary enema. 

Administration of remedies by the rectum is an important resource 
to the therapeutist in cases of inability to swallow, irritable stomach, 
and in children's maladies. Unfortunately, this organ soon becomes 



14 HOW MEDICINES ARE INTRODUCED. 

intolerant, the mucous membrane irritable, and the medicament is 
either at once rejected or absorption delayed. 

When should Medicines be administered? — The curative effects of 
remedies may be retarded, changed in form, or prevented, by untimely 
administration. 

Remedies that are intended to act on the mucous membrane of 
the stomach only should be given when the organ is empty. If distant 
parts are to be affected in the most prompt and efficient manner, and 
the remedy is free from any distinctly irritating quality, it should 
also be taken on an empty stomach. As, when digestion is going on, 
the contents of the stomach are acid in reaction, if alkalies are admin- 
istered, combinations take place, and salts are formed. Various or- 
ganic substances are decomposed and, it often happens, rendered inert 
by the action of the stomach acid. If alkalies are introduced before 
digestion begins, diffusion of the acid-forming constituents of the 
blood no doubt takes place, and in this way the acidity of the gastric 
juice is promoted. The law of diffusion just given is equally applica- 
ble to acids ; given before meals, they increase the diffusion of alkaline 
constituents of the blood toward the stomach. 

The mineral acids, especially hydrochloric and phosphoric, increase 
the activity of pepsin when administered during the process of diges- 
tion, and alkalies given before digestion, begins have the same effect to 
some extent, but, if taken during this process, retard or suspend it. 
Alcohol in considerable quantity lessens the activity of pepsin, but a 
small amount increases it. Five per cent, is probably the limit, and the 
larger the quantity beyond that the greater the injury to digestion 
(Klikowiz). The germicides or antiseptics interfere with the process 
of digestion in proportion to their power ; hence the bichloride, the 
biniodide, and permanganates are the most injurious to pepsin. It fol- 
lows that such agents should be given when the stomach is nearly or 
quite empty, free dilution serving to prevent injury to the mucous 
membrane. The sulphates, especially of the metals, nitrates, chlo- 
rates, bromides, salicylates, in the order named, decidedly lessen the 
ferment power of pepsin, and consequently retard digestion. None of 
these should be given during the period of digestion, but as long be- 
fore or after as the circumstances will permit. 

Remedial agents intended to enter the blood with the food must 
needs be given during the time when the conversion of foods is going 
on. Iron, the hypophosphites and phosphates, and certain lime-salts 
are of this character, but these remedies should be selected with refer- 
ence to their action on the digestive fluids. Thus, according to the 
observations of Eccles, the hypophosphite of potassium, phosphate of 
iron, lactophosphate of calcium, citrate of iron, are among those exert- 
ing comparatively little effect on the process of digestion, while 
others, heretofore supposed to be free from injurious action, are 



BY THE SUBCUTANEOUS AREOLAR TISSUE. 15 

especially hurtful. While the stomach contents are decidedly acid, 
those of the small intestine are alkaline, and sufficiently so to neu- 
tralize the stomach acid, and to maintain the alkalinity of the in- 
testinal juices. When, therefore, it is required to have the medica- 
ment act on the small intestine, the best time to secure that object 
is when the flow of materials is in that direction, and, other things 
being equal, by combination with alkalies if the nature of the sub- 
stance will permit. 

Medicines intended to affect the hepatic and pancreatic secretions 
need to have ample time, and should be so administered as to begin 
their action when the periods of physiological activity arrive. 

Applications to the Genito -Urinary Mucous Membrane. — 
Brown-Sequard has proposed to utilize the bladder for securing ab- 
sorption of remedial agents in cases of great intestinal disorder, as in 
cholera. Experiment has shown that morphine, for example, is taken 
up with considerable rapidity by this viscus. 

Topical applications to the urethra and vagina are very frequently 
made, usually in the form of astringent injections. Suppositories, 
variously medicated, are also occasionally used in the treatment of 
affections of these parts. 



III. 

BY THE SUBCUTANEOUS AREOLAR TISSUE— THE HYPODERMATIC OR 
HYPODERMIC METHOD. 

The term hypodermatic is used in conformity with the nomencla- 
ture already existing — as " epidermic," " endermic," etc. — but the ter- 
mination of the word is now altered in deference to the opinions of 
the best philologists. The term hypodermic, which has been univer- 
sally adopted, is known to be formed on wrong principles, and hence, 
in accordance with the rules of construction, the word hypodermatic 
is substituted. As the term indicates, by this method the medicine is 
applied to the subcutaneous areolar tissue. This does not include the 
method of " inoculation," introduced by Laf argue, nor that proposed 
by Luton and Bertin, which consists in the injection of irritants into 
diseased tissues. It is obvious that by the hypodermatic method 
medicines can be introduced only in the state of solution. To intro- 
duce the solution under the skin, a special instrument is necessary. 
This is the now well-known hypodermatic syringe — a small syringe 
having a capacity not to exceed a drachm — the nozzle being a hollow 
needle having a lancet-shaped extremity for easily transfixing the skin. 
These instruments are various in form and construction, and are made 
of gold, silver, glass, or hard rubber. The most efficient instrument 
for ordinary use is the silver hypodermatic syringe described by the 



1G HOW MEDICINES ARE INTRODUCED. 

author. The piston-rod of this instrument should be semi-cylindrical 
and should be graduated for minims on its flat side, to indicate the 
quantity of solution contained in the barrel. Glass hypodermatic syr- 
inges break easily, and the mountings work loose and give way. Now, 
however, the glass cylinder is in part inclosed in a metal sheath, for 
greater strength and security. A graduated hypodermatic syringe 
should not be used until the exact value of the divisions of the scale 
has been determined by comparison with a standard minim-glass. A 
very important part of the instrument is the needle. The best are 
made of gold, with an iridium point, which is indestructible and does 
not become dulled, but they are expensive. The ordinary steel needle 
suffices if well made and afterward kept in good order. The sharper 
the needle-point, provided it be of proper shape, the less painful in 
insertion. It should not be forgotten that contagium may be trans- 
ferred by careless use of the needle, and that dirt injected will cause 
inflammation. 

A medicine employed for hypodermatic use should be capable of 
perfect solution in the menstruum, which is usually distilled or pure 
water. Particles of medicine undissolved are not only not in a condi- 
tion for ready absorption, but are irritant to the tissues, producing in- 
flammation and abscess. The solution for hypodermatic use should be 
free from foreign matter of every description and should be neutral in 
reaction, or, at least, without decided acid or alkaline property. Any 
substance which will coagulate the blood or produce violent local irri- 
tation is unfit for hypodermatic use. A solution of even a neutral sub- 
stance should not be too concentrated. Clean water, free from visible 
impurities, is entirely harmless, and the quantity of fluid injected is, 
within certain limits, a matter of indifference, provided suitable care be 
used in selecting the site and injecting. On the other hand, concen- 
trated solutions are more apt to produce local irritation than dilute 
solutions. Moreover, a drop too much of a concentrated solution of a 
powerful alkaloid may produce an alarming, if not dangerous state. 
In ordinary syringes a few drops remain at the bottom of the barrel 
and in the needle — whence it follows, in using strong solutions, it is 
difficult to inject the precise amount desired. 

Solutions of alkaloids, too long kept, become unfit for use hypoder- 
matically, by reason of the development in them of a penicillium, a 
minute organism which grows at the expense of the alkaloid. Fresh 
solutions should be made when needed. When hypodermatic injec- 
tions are used infrequently, it is preferable to prepare an extempore 
solution, using powders of a definite strength. Filtered river, melted 
ice, or rain water, may be used for dissolving the powders. Solutions 
prepared extemporaneously from ordinary spring or rain water are 
found to produce less inflammation, and are less likely to be followed 
by abscess, than solutions prepared with pure distilled water which 



BY THE SUBCUTANEOUS AREOLAR TISSUE. 17 

have been kept for several days. The author, therefore, advises the 
use of extemporaneous solutions made with powders of suitable strength 
or the compressed tablets now prepared by the manufacturing phar- 
macists. 

In practicing the hypodermatic injection it is important to avoid 
puncturing a v^ein. Serious depression of the powers of life and sud- 
den and profound narcotism have been produced by injecting a 
solution of morphine directly into a vein. Fatal collapse may en- 
sue from injecting air into a vein along with the narcotic solution. 
Bony prominences ought to be avoided, and also inflamed parts. It 
is not necessary to follow Wood, the discoverer of the hypoder- 
matic method, who advised that the solution be inserted at those 
points where pain can be awakened by pressure (the painful points 
of Valleix). Some exceptions to this rule undoubtedly exist. The 
arms, the abdomen, the thighs, the calves of the legs, and the back, 
are suitable places. Eulenburg makes the assertion that the effect is 
slower when the injection is made in the back, but I have not ob- 
served this difference. 

Solutions. — When the quantity of the medicament to be used 
hypodermatically is sufficient in bulk, the most convenient mode of 
procedure is to prepare extemporaneous solutions from powders or 
compressed tablets of definite weight. Experience has abundantly 
proved that clean river, cistern, spring, or well water, is better than 
distilled water for preparing solutions. If not very recently distilled, 
the water soon becomes turbid from the development in it of a 
minute vegetable organism — a penicillium — which grows at the ex- 
pense of the alkaloid, and thus as it increases in impurity also les- 
sens in strength. The antiseptics — such as carbolic acid, chloroform, 
salicylic acid, cherry laurel, etc. — do not succeed in preventing the 
development of the parasite for any considerable period unless 
added to the solution in such quantity as to render it very irritat- 
ing. The least objectionable, and at the same time the most effect- 
ive comparatively, is chloroform-water (aqua chloroformi), which is 
made by saturating freshly-distilled water with chloroform, about 
two minims being required for the ounce. The better method is to 
make use of ordinary clear water, and to prepare the solution at the 
time it is required for use. Heating the water to the boiling point 
is also a highly useful expedient, for this temperature is sufficient to 
kill the organism referred to, and to render innocuous any organic 
matter present. 

" Hypodermic tablets," as they are designated, are now made by 
the manufacturing pharmacists on an extensive scale. They have the 
advantage of permanence of form, solubility, and accuracy of dose. 
When very minute doses are required, a vehicle becomes necessary. 
Some manufacturers use beet-root sugar for the purpose ; others, sul- 
3 



IS HOW MEDICINES ARE INTRODUCED. 

phate of soda ; but the latter is the more commendable because it is 
soluble, aud undergoes no change. Sugar, although soluble, has the 
serious disadvantage that it is liable to decomposition, and thus to 
produce local troubles. 

FORMULA. 

Mobphina — Morphine. 1£ Morphine sulphat., gr. xvj ; aquae, vel aquas 
chloroformi, § j. M. Sig. : Two (2) minims are equal to one-fifteenth of a grain. 

An antiseptic solution of morphine, intended to be kept for several weeks, 
may be prepared according to the following formula : 

3 Morphine sulph., gr. xvj; acid, carbolic, gtt. v; aquae, §j. M. Sig.: 
Two minims contain y 1 ^ of a grain of sulphate of morphine. 

Solutions of morphine may be readily prepared extemporaneously from pow- 
ders or pellets of a definite strength, as follows : 

3 Morphinae sulphat., 3j; atropinae sulphat., gr. ss. M. ft. pulv. no. cxx 
(120). Sig. : Each powder contains \ of a grain of morphine and -^ grain of 
atropine. 

Ateopina — Atropine. 3 Atropinae sulphat., gr. ij ; aquae, § j. M. Sig. : 
One minim contains -^-^ of a grain. Three (3) minims contain fo of a grain, 
which is a maximum dose for many persons. 

Moephixa and Ateopina. — 3 Horphinae sulphat., gr. xvj ; atropinae sul- 
phat., gr. ss. ; aquae, vel aquae chloroformi, f j. M. Sig. : Six (6) minims con- 
tain £ grain of morphine and T ^ grain of atropine. 

Cooaixa — Cocaine. IJ Cocainae hydrochlor., gr. xxiv ; aquae, vel aquae 
chloroformi, § j. M. Sig. : One grain to 20 minims. 

Ueethan. — IJ Urethan, 3j; aquae, §j. M. Sig.: Each drachm contains 
7£ grains. 

DrjBoisiNA. — Duboisine. IJ Duboisinae sulphat., gr. j ; aquae, §j. M. Sig.: 
Four (4) minims contain T ^ of a grain. Eight minims is the usual maximum 
dose for an adult. 

Htosoyamina — Hyoscy amine. IJ Hyoscyaminae sulph., gr. j; aquae, f j. 
M. Sig. : Five (5) minims contain -^g- grain. 

Hyoscine, the other alkaloid of hyoscyaraus, is the better hypnotic. It is 
amorphous, but may be giren hypodermatically, as follows: 

IJ Hyoscinae, gr. ij ; glycerini, aquae, aa IT], c (100 minims). M. Sig. : 
Each minim contains -^ of a grain. 

Stbyckxina — Strychnine. IJ Strychninae sulphat., gr. j; aquae, |j. M. 
Sig. : Ten (10) minims contain ^ of a grain. 

Conixa — Conine. IJ Coninae hydrobromat., gr. j; aquae, §j. M. Sig.: 
Ten (10) minims contain -^ of a grain. 

Cueaea — or Woorara. IJ Curarae, gr. j; acid, acetic, TTlv; aquae, ad TH, c 
(to 100 minims). M. Filter. Sig. : Ten (10) minims contain T V of a grain. 

As the active constituents of curara are soluble in water, an aqueous solution 
will contain them— the residue being woody fiber, starch-granules, etc. As, 
however, the specimens vary greatly in strength, the character of any new 
specimen should be ascertained by trial on animals before giving it to man. 

Any salt of the alkaloid, curarine, will, however, be more exact in its effects. 

IJ Curarinae sulphat., gr. j ; aquae, § ss. M. Sig. : Four (4) minims con- 
tain -jV of a grain. 



BY THE SUBCUTANEOUS AREOLAR TISSUE. 19 

Nicotiana — Nicotine. 3 Nicotianae hydrobromat., in, j ; aquae, 3 iv. M. 
Sig. : Four (4) minims contain -^ of a grain. 

Lobelina — Lobeline. IjS Lobelinae hydrobromat., gr. i; aquas, 3 ij. M. Sig.: 
Four minims contain ^ grain. 

Aoidum Htdeooyanioum Diltjtum. — IJ Acid, hydrocyanic, dil., q. s. Sig.: 
Four minims is the maximum single dose. 

Eseeina — Eserine. The extract of Calabar-bean dissolved in sufficient water, 
and filtered, is used hypodermatically, sometimes ; but the alkaloid eserine is to 
be preferred. 

IJ Eserinae sulph. vel salicylat., gr. j; aquae, 3 iv. H. Sig.: Four (4) 
minims contain -fa of a grain. 

Pilocarpina — Pilocarpine. ]$ Pilocarpines hydrochlorat., gr. xvj ; aquae, 
§ j. M. Sig. : Five (5) minims contain (£) one sixth of a grain. 

Amyli Nitritum — Nitrite of Amyl. From three (3) to five (5) minims of 
amyl nitrite can be injected subcutaneously at a time. The repetition of the 
dose will depend on the effect, but the injection may be practiced every half 
hour for a time. 

Chloroformum Pttrificatum — Purified Chloroform. From five (5) to fifteen 
(15) minims can be used at one injection. This agent is employed by the " deep 
method" — i. e., the chloroform is thrown by the syringe deeply and in the neigh- 
borhood of the nerve-trunk, the seat of pain. 

The official spiritus chloroformi has also been used successfully in the same 
group of cases. 

Alcohol and Ether are also injected subcutaneously — alcohol in the diluted 
form, as whisky or brandy, and pure ether. 

Ohloeal Hydeate. B Chloral, hydrat., § ss. ; aquae, § j. M. Sig. : Thirty 
(30) minims contain fifteen (15) grains of chloral. 

Sometimes it is advantageous to give chloral and morphine together. 

Caffeina— Caffeine. I£ Caffeinae, gr. xxiv; glycerinae, aquae, aa | ss. M. 
Sig. : Twenty minims contain one grain. 

Apomoephina— Apomorphine. IJ Apomorphinae, gr. j. Ft. pulv. no. xvj. 
Sig. : One or more may be dissolved in sufficient water as required. 

Apomorphine undergoes a change in the presence of moisture, especially 
when kept in solution for some time ; hence the solution for hypodermatic in- 
jection should be prepared when required. The dose ranges from T \ of a grain 
to £ of a grain. 

Ergota— Ergot. 1$ Ext. ergotae, 3j; aquae, fj. M. Sig.: Twenty min- 
ims contain two (2) grains. 

Quentina— Quinine. " 1$ Quininae disulphat., gr. 1 (50) ; acid, sulphuric, 
dil., m c (100); aquae font., f j ; acid, carbolic, liq., HI v (5). Solve. 

" Place the quinine and water in a porcelain dish over a spirit-lamp; heat 
to the boiling-point, and add the sulphuric acid, stirring with a wooden spatula. 
Filter at once into a bottle, and add the carbolic acid. This gives six grains to 
the drachm." [Lente's formula.] 

Quinina Umuriatica carbamidata, a combination of quinine and urea, is 
freely soluble— in equal parts of water, in fact — and therefore a most useful 
preparation for hypodermatic use. 

IJ Quininae hydrobromat., gr. xlviij ; aquae destil., 3 iv. M. Dissolve, and 
by heat if necessary. Sig. : Twenty (20) minims contain 4 grains. 



20 HOW MEDICINES ARE INTRODUCED. 

The new antipyretics, antipyrine, acetanilid, exalgine, and some others, hav- 
ing been found to possess analgesic power, are now used hypodermatically for 
the relief of certain kinds of spasmodic and painful diseases. 

Acidttm Carbolicum — Carbolic Acid. IJ Acid, carbolic, purif., gr. x ; aquaa, 
§ j. M. Sig. : Eight minims contain £ of a grain. 

The quantity administered will range from one sixth of a grain to two or 
three grains. 

Hydrargyrum — Mercury. The solutions of mercury now chiefly used are 
those of the corrosive chloride, the albuminate, and the formamide, as prepared 
by Liebreich. 

5 Hydrarg. chlor. cor., gr. j ; aquaa, § j. M. Sig. : Ten (10) minims con- 
tain ^ of a grain. 

Various albuminous solutions of mercury have been proposed : the chlorides 
of mercury, ammonium, and sodium, mixed with albumen. 

Arsenicum — Arsenic. The preparations of arsenic used hypodermatically are 
Fowler's and Pearson's solutions; the former in doses from two (2) to ten (10) 
drops, and the latter in twice the quantity. 

Aqttapuncture. — By aquapuncture is meant the injection of pure water 
beneath the skin. A special instrument has been invented to effect this; but 
ordinarily a hypodermatic syringe will suffice for this purpose. From a half- 
drachm to a drachm is thrown under the skin over the organ or part on which 
it is intended to act. 

Irritant Injections. — Injections intended to excite local inflammation are 
also employed in various morbid states. The materials so used, and the condi- 
tions requiring them, will be set forth hereafter. 



IV. 

DY THE VEINS. 

The injection into the veins of medicinal agents is dangerous or 
not, according to the character of the material so used. Numerous 
experiences have demonstrated the safety of ammonia injections, and 
Prof. Ore, of Bourdeaux, has practiced the intra-venous injection of 
chloral to induce anaesthesia. Formerly, before the introduction of 
the hypodermatic method, the injection of medicines directly into 
the blood was suggested and occasionally practiced in cases of as- 
phyxia, in the collapse of cholera, in the insensibility due to nar- 
cotic poisons, etc. At present this method is restricted within nar- 
rower limits. Some remarkable results have been obtained by the 
injection of a saline solution into the veins in cases of the collapse 
of cholera. Unfortunately, the appearances of improvement, which 
are very remarkable, are not usually sustained, although Little re- 
ports five recoveries out of twenty apparently hopeless cases treated 
in this way. During the last epidemic of cholera in Europe (1886), 
intra-venous saline injections were more used than formerly, and, it 
is alleged, with a far greater measure of success. Hayem recom- 



TRANSFUSION. 21 

mends the following formula as a close approximation to the compo- 
sition of blood-serum : 

Water 3 oz. 

Hydrate of sodium 15-J- grains. 

Chloride of sodium 80 grains. 

Sulphate of sodium 6^ drachms. 

The temperature of the fluid injected should not be greater than 
100° Fahr., and the amount which experience has shown to be well sup- 
ported is not greater than two litres, and usually one litre (a quart) is 
sufficient for one operation. The fluid should be injected slowly, ac- 
cording to Potain, at such a rate that not more than 20 cubic centi- 
metres pass into the blood in a second. Dr. Histon Fagge has recently 
reported a case of diabetic coma, in which the injection of twenty-six 
ounces of a warm solution of salines (phosphate and chloride of soda) 
produced an astonishing improvement in the condition of the patient. 
A suitable saline solution for intra-venous injection may be made of 
phosphate, carbonate, and choloride of sodium, dissolved in water at 
the temperature of 100° Fahr. until the specific gravity of 1020 is at- 
tained. The instruments employed for transfusion of blood may be 
used for the intra-venous injection of salines. 

Halford, of Australia, has recently practiced the injection of am- 
monia into the veins, in the treatment of the bite of venomous snakes. 
He employs one part of the stronger aqua ammonioe to two parts of 
distilled water, the injection being made with an ordinary hypodermat- 
ic syringe. A vein in a convenient situation is selected, the needle is 
inserted into it, and the solution of ammonia is thrown in gradually. 
The operation may be repeated, as necessary, the guide to the repetition 
of the injection being the state of the circulation. Fayrer shows that 
this practice is not successful in the systemic condition caused by the 
bite of the venomous snakes of India, and the special committee of the 
Medical Society of Victoria, appointed to investigate the subject of 
the intra-venous injection of ammonia, report adversely to the claims 
of Halford. The proposer of this expedient has, at least, demonstrated 
the safety of the intra-venous injection of ammonia ; and, although 
his first claim has been shown to be incorrect, the method itself has 
been utilized in other maladies : for example, in chloroform asphyxia, 
opium narcosis, hydrocyanic-acid poisoning, etc. Failure of the 
heart's action and thrombosis of the pulmonary artery, post partum, 
are also indications for the intra-venous injection of ammonia. 

Attention has been called elsewhere to an instance reported by Dr. 
Eskridge, which is remarkable both as to the injection and as to the 
results obtained. By an error, undiluted aqua ammonia was injected 
directly into the blood-current, but no untoward effects accompanied 
or followed, and the curative action exerted in the malady was most 
successful. Although, at one time, the escape of ammonia was sup- 



gg HOW MEDICINES ARE INTRODUCED. 

posed to be the cause of the coagulation of the blood, and although 
this is no longer held as a theory, it has served to demonstrate the 
fact that such intra- venous' injections can be practiced without ill 
effects, immediate or remote. 

Transfusion. — This consists in an operation for substituting healthy- 
blood for the abnormal fluid occurring in certain diseases, and for sup- 
plying blood in cases in which a deficiency exists by reason of haemor- 
rhage. Ordinarily the blood of a healthy adult is used in transfusion, 
because ever since the time of Blundell it was supposed the blood of 
an animal would not functionate properly in the arterial system. This 
notion is now, however, fully exploded, and Gesellius has especially 
shown, in his elaborate monograph on transfusion, that lamb's blood 
will answer the same purpose in the human system as human blood. 

As the red globule is the vivifying constituent of the blood, and as 
the fibrin is non-essential to the most important office, at least of the 
circulating fluid, it is obvious that defibrinated blood may be used for 
transfusion. According to the statistics collected by Gesellius, of one 
hundred and forty-six cases of transfusion with blood without defibri- 
nation, seventy-nine, or 54'1 1 per cent, were successful, and, of one 
hundred and fifteen cases in which defibrinated blood was used, sev- 
enty-nine, or 68 # 70 per cent, proved fatal. Mr. Higginson, of Liver- 
pool, reports thirteen cases occurring under his own observation, in 
which mediate transfusion with pure blood was employed, with the 
result of six successful. The injection of defibrinated blood is free 
from one source of danger — the introduction of clots into the circula- 
tion — which, as Panum has shown, will be followed by the disastrous 
result of multiple embolisms, or thrombus of the pulmonary artery. 
Separating the fibrin, however, renders the blood much less capable of 
performing its office. The necessary agitation in order to coagulate 
the fibrin injures the blood-globules, and the fibrin itself is necessary 
to prevent transudations and the recurrence of haemorrhage. With 
the improved instruments now used for the operation, and with the 
exercise of the necessary care, there need be no formation of clots, the 
chief danger in the use of blood containing its fibrin. 

Transfusion may be mediate or immediate. Mediate transfusion 
consists in the reception of the blood in a suitable vessel, and its trans- 
ference by means of an injecting apparatus into the veins of the pa- 
tient. Immediate transfusion consists in an apparatus for making di- 
rect communication, from the vein of the person or animal furnishing 
the blood, with the vein of the patient receiving it. A number of ap- 
pliances have been invented for mediate transfusion. Martin, of Ber- 
lin, has used in his operations a glass syringe provided with a suitable 
canula for insertion into the vein. Belina invented an apparatus con- 
sisting of a receiver for the blood, a hand-ball like that of the spray- 
douche, and a flexible tube provided with a stop-cock and canula. Beli° 



TRANSFUSION. 23 

na, who has treated at great length of the operative procedure, decides 
that all forms of syringes are objectionable. Higginson proposed and 
has used successfully an instrument similar to the enema-syringe in- 
vented by him. This apparatus can, however, only be used for mediate 
transfusion. As immediate transfusion is to be preferred, as a rule, it 
were better to be provided with a suitable instrument for this opera- 
tion. The instrument invented by Dr. Aveling, and presented to the 
Obstetrical Society of London in 1864, is at the same time the simplest 
and most effective. This consists of a hand-ball and flexible tubes 
like a Davidson syringe, but without valves. There are two canulae 
attached to either extremity of the flexible tubes — one for insertion 
into the vein furnishing the blood, and the other for insertion into the 
vein receiving it. The small-sized Davidson syringe will answer per- 
fectly well by removing the valves, the action of which tends to sepa- 
rate the fibrin, and fitting to the flexible tubes suitable perforated nee- 
dles or canulae. In using Aveling's instrument it must be first put into 
water at the temperature of 100° Fahr., and it must be filled with warm 
water, or better, a warm solution of phosphate and chloride of sodium 
of a specific gravity of 1020. The object of this is to exclude the air 
from the apparatus. The next step consists in inserting the canula in a 
vein — usually of the forearm — of the person or animal furnishing the 
blood, and in a position so that the blood-current will be in the direc- 
tion of the current in the patient receiving it. Should the veins of the 
patient be collapsed, the skin overlying those at the elbow may be 
transfixed and raised, which will bring into view a vein into which the 
canula may be inserted — care being used here that the direction of the 
current shall be toward the heart. The canulae can be held in position 
by the fingers of assistants. The operator compresses the bulb gently, 
pressing at the same time the supply-tube between the thumb and fin- 
ger of the other hand, in order to prevent a reflux of the fluid. When 
the bulb is emptied, the delivery-tube is pressed between the thumb 
and finger shifted from the supply-tube, and the bulb is allowed to fill 
with blood from the source of supply. In this way, successive charges 
of fresh blood can be delivered without difficulty into the patient's 
vein. The aspirateur may be used in the same way for immediate 
transfusion, as has been suggested by Dr. J. W. Howe, of New York, 
who has used it successfully. He advises the substitution of smaller 
tubes than those which accompany this instrument, and he has devised 
suitable canulae for the veins. 

The quantity of blood which it is advisable to introduce varies 
from four to eight ounces. The smaller amount is generally more suc- 
cessful. Too large an amount will seriously embarrass the heart. A 
further precaution is necessary as to the manner of injection ; force 
is never necessary, and may be very injurious ; the blood should be de* 
livered into the vein slowly and gently. 



04 HOW MEDICINES ARE INTRODUCED. 

Besides the danger arising from coagulation of the blood and the 
formation of thrombi, immediate bad symptoms or fatal syncope may 
come on from the introduction of air into the veins. The utmost care 
is necessary to exclude air from the apparatus. Phlebitis may also 
ensue from the injury done to the vein, and the patient's life be put in 
jeopardy from this cause, but this is a danger much more remote than 
the introduction of air and clots into the circulation. 

As a number of successful cases of transfusion (Gesellius, Hasse, 
and others) have been reported in which lamb's blood was used, the 
practitioner is now justified in its employment, notwithstanding Landois 
has shown by experiment that transfusion of mixed blood does injury 
to the red blood-globules. If lamb's blood is to be used, the animal 
should be sufficiently anaesthetized to keep it quiet, and it should be 
securely tied. A vein may be selected, and immediate transfusion 
performed with Aveling's instrument or with the aspirateur in the 
mode already described. 

Transfusion is especially indicated in cases in which life is put in 
imminent jeopardy by hemorrhage. According to Belina, it is in 
haemorrhage from abortion, and during the first months of pregnancy, 
that transfusion is most successful. Of thirteen cases of haemorrhage 
from abortion thus treated, according to this author, eleven had a 
fortunate issue. Of the cases of postpartum hemorrhage — eighty -five 
in number — in which this expedient was adopted, fifty-six resulted 
favorably. Routh, Soden, Hicks, McDonnell, Mudge, Howe, and 
others, have reported successful cases, not included in the statistics of 
Belina. In other forms of haemorrhage, hematemesis, intestinal hem- 
orrhage, epistaxis, etc., in which death by exhaustion is imminent, the 
operation of transfusion is proper. Belina has collected twenty-six 
cases of traumatic hemorrhage, of which twelve resulted favorably, 
in two the result was doubtful, and twelve terminated fatally. 

Transfusion has also been employed in certain morbid states of the 
blood, but not with encouraging results. Thus, Belina has collected 
a number of cases belonging to this category, of which nineteen termi- 
nated favorably, in two the result was equivocal, in three temporarily 
beneficial, and thirty-nine died. Two very interesting cases of the 
hemorrhagic diathesis successfully treated by transfusion have been 
reported by Dr. Joseph Buchser, of New York. This form of consti- 
tutional cachexia is especially an indication for transfusion. In the 
treatment of anemia this operation has not been successful. Thus, 
three cases treated by Stohr, of Wiirzburg, terminated fatally. Cases 
have also been reported by Concato, Cavaleri, and others. Transfusion 
has been used very successfully in cases of carbonic-oxide poisoning 
(Uterhart, Prof. Konig, Prof. Martin), and in phosphorus-poisoning 
(Prof. Jurgensen). 

Eulenburg and Landois advise transfusion in cases of danger to life 



TRANSFUSION. 25 

from poisons for which there are no antidotes. It has been recom- 
mended, in such cases, to abstract blood and to supply fresh blood to 
the suffering organism. Nussbaum has employed transfusion with 
complete success in epilepsy, and it has also been used with favorable 
results in eclampsia due to urmmic poisoning. 

Arterial Transfusion. — Prof. Albanese has proposed injection of 
defibrinated blood into an artery, either the radial or posterior tibi- 
al, as a substitute for the intra- venous injection. The artery is ex> 
posed, punctured, and the blood thrown into it, in the same way as 
in the operation on the vein. It is claimed for this method that 
thrombosis is less apt to occur, and that the danger arising from the 
introduction of air is obviated. When a large amount of blood is 
necessary, it is more safely introduced by the arterial system, because, 
having to traverse the capillaries before reaching the right side of 
the heart, sudden distention of this organ is avoided. Prof. Htiter, 
who has especially advocated this method, reports a number of cases 
successfully performed in this way, and Asche has collected a number 
of others. 

Transfusion of Milk. — The experiments of Donne on animals 
demonstrated the harmlessness of the intra-venous injection of milk. 
Hodder, of Canada, was the first to employ this expedient on man ; 
and, of three cases of cholera collapse which he thus treated, two re- 
covered. Thomas, of New York, has also transfused milk with success 
in postpartum hemorrhage ; and Wagstaff has failed twice with the 
same method in traumatic haemorrhage. Within the present year 
(1880) Mr. Arthur Meldon has published an account of three cases in 
which the transfusion of milk was performed with success. 

When milk is used for transfusion, it should be fresh and directly 
from the cow if practicable, and its temperature should be that of the 
blood itself — 100° Fahr. Not more than four to six ounces should be 
injected at one time, lest the heart be paralyzed by over-distention. 
The effects which follow the intra-venous injection of milk are very 
much the same as those produced by blood, except that they are prob- 
ably less permanent, and that albuminuria is a frequent result. That 
this expedient is as useful as blood transfusion by the immediate 
method has been strongly maintained, but the most recent experience 
does not justify this opinion. Indeed, it is probable that the chief 
value of blood transfusion, in functional diseases, is to gain time for 
the operation of other and more permanent measures (Pepper). We 
also agree in the estimate of Dr. Pepper that transfusion in any of its 
forms is without utility in important organic diseases. 

In an experimental inquiry into the methods of transfusion, Schafer 
has examined anew the question of the substitution of some other fluid 
for blood, deciding with Landois, of Germany, and Howe and Dupuy, 
of America, that the introduction of any other fluid does injury to the 



26 HOW MEDICINES ARE INTRODUCED. 

corpuscles, and that a fluid without hemoglobin can not functionate 
as blood. As respects the substitution of the blood of some other 
animal — lamb's blood, for example — the conclusion of Schafer is in 
accord with the previously expressed judgment of Landois, that only 
human blood should be used in transfusion on man. Schafer has also 
made some important observations on the best mode of performing 
the operation. He finds that the best results are obtained on animals 
by arterial transfusion, and recommends that the dorsal artery of the 
foot be used for receiving and furnishing the blood in the operation 
on man. When the artery is used the blood is received into that part 
of the vascular system where it is most needed, and only an elastic 
rubber tube and glass canula are required, the force of the donor's cir- 
culation being sufficient to propel the blood. There is no danger of 
the supply from the donor becoming excessive, as the pressure in the 
arterial systems of the donor and of the recipient soon acquires the 
same force. Usually, and indeed unless the circulation in the donor 
is feeble, no other medium of communication is necessary besides the 
flexible tube and glass canula, as the elastic pump of Aveling's instru- 
ment does not contribute to the force of the flow. The tube and 
canulae should be filled with carbonate-of-soda solution, both to exclude 
air and to prevent clots forming. It is not necessary to measure the 
quantity of blood, as the condition of the recipient furnishes the true 
indications to be followed. 

Peritoneal Transfusion. — To the various kinds of transfusion must 
now be added this form, originally proposed by Ponfick. With anti- 
sejotic precautions, a trocar with canula is passed through the abdomi- 
nal walls in the linea alba. A flexible tube, with a glass funnel at- 
tached, is then connected with the canula — the trocar being withdrawn 
— and defibrinated blood is poured into the cavity. Excellent results 
follow this practice, which the researches of Bizzozero and Golgi have 
shown to be based on sound physiology. This method has been used 
successfully by Yon Kaczorowski and others in the various maladies 
in which the other modes of transfusion have been employed. Some 
adverse reports have, however, been made. Peritonitis has been 
caused by the procedure, but in these cases the subjects operated on 
may have been unsuitable ones. On the whole, peritoneal transfusion, 
which at one time promised to be a valuable measure, must be regarded 
as still subjudice — if, indeed, its utility is not questionable. 

Dr. Joseph W. Howe, of New York, who has made many valuable 
observations on transfusion, in a recent issue of the "New York 
Medical Journal" (February 3, 1883), announces that no other expedi- 
ent can be properly substituted for the intra-venous injection of blood. 
When life is endangered by hemorrhage, Dr. Howe holds that it is 
not advisable to wait for intestinal or peritoneal absorption, but that 
intra-venous transfusion should be practiced without delay. 



TRANSFUSION. 27 



Authorities referred to : 



Albanese. Berliner klinische Wochenschrift, 1870, p. 470. 

Asche. Die neuern Mittheilungen uber Transfusion des Blutes. Schmidt's Jahrbiicher 
der gesammten Medicin, vol. cl, p. 329. 

Aveling, Dr. J. H. Lancet, vol. ii, 1872, p. 147. 

Belina. Archives de Physiologie, Normale et Pathologique, 1870, p. 43, et seq. 

Bennett, J. Hughes. The Practitioner, vol. i, p. 211. 

Brown-Sequard. Lectures on the Diagnosis and Treatment of Functional JS r ervous 
Affections, part i, Philadelphia, 1868. 

Buchser. The Medical Record, October 1, 1869, p. 337. 

Eccles, Dr. R. Gr. Drugs and Digestion, New York Medical Journal, November and 
December, 1886. 

Erlenmeyer. Die subcutanen Injectionen der Arzneimittel, dritte Auflage, Neuwied, 
1866. 

Eulenburg. Die hypodermatische Injectionen der Arzneimittel, zweite Auflage, Berlin, 
1867. 

Eulenburg und Landois. Ueber des Transfusion des Blutes, as quoted by Belina. 

Fagge. Guy's Hospital Reports, vol. xix, 1874, p. 173. 

Gesellius. Die Transfusion des Blutes, eine historische, kritische und physiologische 
Studie, St. Petersburg, 1873. 

Halford. Medical Times and Gazette, vol. x, 1870, pp. 83, 278. 

Hayem. Bui. Gen. de Therap., vol. cvii, p. 32. 

Hicks. Guy's Hospital Reports, 1869, p. 1. 

Higginson. Liverpool Medical and Surgical Reports, vol. v, p. 104. 

Huter. Berliner klinische Wochenschrift, 1870, p. 470. 

Jurgensen. Berliner klinische Wochenschrift, 1871, No. 21. 

Kiklowicz. From Vratch : Virchow und Hirsch's Jahresbericht, 1886. 

Little. The Medical Times and Gazette, London, 1867, p. 354. 

Landois. Berliner Centralblatt. Abstracted in Schmidt's Jahrbiicher for 78, 75. 

McDonnell. Dublin Quarterly Journal, May, 1870. 

Panum. Experimented JJntersuchungen ueber Transfusion, Transplantation oder 
Substitution des Blutes. Virchoio's Archiv, xxvii, p. 249. 

Pepper, Prof. William, M. D. Paper read before the Medical Society of the State 
of Pennsylvania. 

Routh. The Medical Times, 1849, p. 144. 

Schafer, E. A. The Lancet, December 13, 1879, p. 876. 

Soden. Medico- Chirurgical Transactions, vol. xxxv, p. 143. 

Von Kaczorowski, Dr. Wiener medicinische Wochenschrift, 1880, No. 46. 

Waller. The Practitioner, London, vol. iii, p. 329. 



PAET II. 

THE ACTIONS AND USES OF REMEDIAL AGENTS. 



THOSE USED TO PROMOTE CONSTRUCTIVE 
METAMORPHOSIS. 

ALIMENTS. 

This extensive subject can, in this work, be considered briefly only, 
and from the point of view of therapeutics. The various aliments are 
of the first importance as remedial agents. No satisfactory repair of 
diseased or wasting tissues can take place without a suitable supply 
of healthy blood, and healthy blood is the product of proper food and 
normal digestion and assimilation. 

The Physiological Relations of Food. — The food of man is 
derived from the three great kingdoms of nature : mineral, vegetable, 
animal. It may be conveniently classified into three principal groups : 
1. Mineral constituents — incombustible or unoxidizable : water, phos- 
phate of lime, chloride of sodium, etc. ; 2. Oxidizable — heat-produc- 
ing and force-forming — carbon compounds : fat, sugar, starch, gum, 
etc. Nitrogenous — flesh-forming : albumen, fibrin, casein, etc, ; 3. 
Food adjuncts — alcohol, acids (citric, tartaric, etc.), alkaloids (caffeine, 
theine, etc.). 

The members of the first group will be discussed hereafter, under 
the head of " agents promoting constructive metamorphosis " ; the sec- 
ond group, the most important, will be considered in this relation, with 
the foods ; and the third will have separate treatment under appro- 
priate heads. 

The classification of foods, originally formulated by Liebig, if not 
too strictly adhered to, is of much utility, as indicating the general 
purposes of these substances in the economy — viz.: carbonaceous or 
force-producers ; nitrogenous or flesh-formers. Under the first divis- 
ion are comprehended fat, starch, sugar, etc. ; under the second, sub- 
stances containing nitrogen, as albumen, casein, etc. There is not, 
however, a rigid line of separation between these two classes, for both 



ALIMENTS. 29 

are more or less concerned in the functions attributed to each, but 
their most important position and office are as assigned by the classifi- 
cation. 

The ultimate uses of food are two : to construct tissues or repair 
them when destroyed by wear ; to supply force — muscular, nervous, 
secretory, etc. The reception, digestion, and absorption of food is 
known as the primary assimilation ; the utilization of the material 
for the growth and repair of the tissues, and by the organs, as force, 
constitutes the secondary assimilation. 

The first step in the primary assimilation is the mechanical subdi- 
vision of the food by mastication. The admixture of the saliva with 
the food facilitates the process of mastication, and, as it contains a 
ferment, ptyalin, which has the property of converting starch into 
sugar, a portion of this constituent undergoes conversion ; but, prob- 
ably, the chief use of the saliva is to give a slight alkaline reaction to 
the mass of food. According to the laws of osmosis, the entrance of 
an alkaline fluid into the stomach hastens the formation of the acid 
gastric juice. In the stomach, under the influence of the ferment, 
pepsin, and the acid (hydrochloric) of the gastric juice, the nitrogenous 
materials — the albuminous constituents of the food, the proteids — are 
transf ormed into peptones. Although fat is necessary to the stomach 
digestion, it does not undergo conversion in the stomach, and escapes 
in a coarse emulsion, with the chyme, into the duodenum. Starch, 
sugar, and gum, also pass into the chyme unchanged, although sepa- 
rated from their proteid envelopes, by the action of the gastric juice, 
except such portions as may diffuse directly into the stomach-veins. 
The peptones, to a large extent, diffuse into the blood from the stom- 
ach, and doubtless, also, such crystalloidal substances as sugar, to 
some extent. The chyme contains parapeptones, starch, fat, sugar, 
and refuse matter remaining undissolved. In the duodenum the acid 
chyme mixes with the alkaline intestinal and pancreatic juices and 
the bile, which are poured out freely as the materials from the stom- 
ach distend the canal. Here the conversion of starch into sugar takes 
place actively, and the fats are emulsionized and to some extent, also, 
saponified. The pancreatic juice not only emulsionizes the fats, but 
separates them into their component fat acids and glycerin, and the 
acids meeting alkaline bases form soaps, which are readily diffusible. 
The action of the bile is also very important. It renders the soaps 
formed soluble, and promotes the emulsionizing of the fats. Its agen- 
cy in the digestion of the fats is well shown in the results of the ex- 
periment for forming a biliary fistula. When the bile is conveyed 
externally, the amount of fat entering the lacteals is much below nor- 
mal, and instead, the fat appears in the stools. In the small intestine 
the proteids which escape conversion in the stomach are transformed, 
under the agency of the bile, pancreatic fluid, and intestinal juice, into 



30 RESTORATIVE AGENTS. 

peptones and other substances, the starch is converted into sugar, and 
the fats are emulsionized, and in part, also, saponified. These nutri- 
tion materials diffuse into the portal veins and into the lacteals, so 
that, by the time the intestinal contents reach the ileo-csecal valve, 
they are composed, for the most part, of excrementitious matters and 
the refuse of the foods taken. 

When the nutrition of the body goes on in the normal manner, 
there exists a certain ratio between the income and the outcome. The 
income consists of the proteids, fats, carbohydrates, salts and water 
of the food, together with the oxygen absorbed from the atmosphere. 
The outcome is made up of the excreta of the respiratory act, consist- 
ing of carbonic acid and water with a little hydrogen ; of the perspira- 
tion, composed of water and salts ; of the urine, which contains the 
nitrogen excreted from the body and a large quantity of saline matter ; 
and of the fasces, composed of excreta from the immense glandular 
apparatus of the ileum and colon, and from the liver. In a perfectly 
healthy condition of the body, after it has attained its full growth, 
there should be an exact ratio between the income and outcome ; the 
income should suffice to furnish the force necessary for the perform- 
ance of the various functions and to repair the waste of the outcome. 
In an ideal dietary, the amount of the food should be sufficient to 
maintain this ratio at the normal standard. 

As respects classification of foods, for the purposes of this work, 
they may be considered under the natural divisions of Animal and 
Vegetable. 

Animal. — One of the most important articles of diet for the sick 
is Beef, which should be of good quality. The bone should not ex- 
ceed 20 per cent ; the fat should be firm, not yellow, and free from 
blood, and should not be in too great proportion relatively ; the mus- 
cle should be firm without being tough, not too pale, nor dark-colored, 
and should not present any marbling or lividity on cross-section. The 
most esteemed parts of the beef are the thigh and hip (round, sir- 
loin, fillet), the loin, and certain parts of the shoulder (rib-roast, 
porter-house steak, etc.). 

Beef varies much in composition, according to the age of the ani- 
mal, the state of its nutrition, the kind of food-stuffs employed to fat- 
ten the beast, and the hygienic character of the animal's environments. 
The age should be four to five years, and the amount of fat appropriate 
to a well-kept and well-fed animal. The best proportions, taking the 
mean of various analyses, Continental and English, are about as follows : 

Water 72-5 

Nitrogenous matters, or albuminates 21 -3 

Eat 52 

Extractives and salts 2*5 



ALIMENTS— ANIMAL. 31 

The composition of cooked meat, according to Moleschott (Parkes), 
is as follows : 

Water 540 

Albuminates 2V6 

Fats 15 45 

Salts 295 

It will be perceived from the foregoing analyses that beef contains ali- 
mentary principles the most important for the nutrition of the body. 
When of good quality, neither too old nor too young, the fat and mus- 
cle suitably proportioned, and not altered by disease, and properly 
cooked, it is the best of the animal foods. The loss of lean beef in the 
process of cooking is about one third of the total weight ; of fat beef, 
about one half. The time required for the complete digestion of beef, 
as ascertained by Dr. Beaumont, is two and three fourths to three 
hours. 

Veal is less digestible and less nutritious than beef, and has a laxa- 
tive action, which may, however, be utilized in states of disease. It 
has the following composition : 

Parts. 

Water 630 

Nitrogenous 16*5 

Fat 158 

Salts , 4-1 

As compared with beef, it is rather slow of digestion, requiring five 
hours or more. It is more albuminous than fibrinous, and abounds in 
gelatin (Fonssagrives). The thymus gland of the veal (sweetbread) 
is, when " plainly cooked (by boiling) and moderately seasoned, a 
very agreeable and suitable dish for the convalescent." — (Pereira.) 

Miction, although possessing a lower degree of nutritive value than 
beef, is one of the most useful of the animal foods, as it is easily di- 
gested. Many patients, however, experience a marked degree of re- 
pugnance to mutton and can not be induced to make use of any article 
of diet containing it. An evident idiosyncrasy exists in some consti- 
tutions against it, so that taken disguised in any way it disagrees with 
the stomach. It does not continue long in favor as the exclusive arti- 
cle of the meat portion of the diet, even with those who relish it for 
occasional use. According to Church, the following is the composition 
of mutton : 

In 100 parts. 

Water 441 

Albumen . . 1 '*! 

Fibrin (true muscle) 5'9 

Ossein-like substances 1*2 

Fat 420 

Organic extractives 1*8 

Mineral matters l'O 

Other substances 2"3 



o~ 



2 RESTORATIVE AGENTS. 



Pbrk contains more fatty matter and more often disagrees than the 
meats above described. Many dyspeptics can not make use of it in 
any form : on the other hand, breakfast bacon may be much relished 
and be easily borne. Pork is rarely prescribed as a diet for the sick, 
but, for convalescents, roasted sucking-pig, which is easily digested, 
may be ordered to vary the food and to stimulate a languid appetite 
Pork differs from beef and mutton in the relatively greater quantity 
of fat. The loss on cooking pork is 50 per cent. Pork, also, yields 
up to water less solid matter, for, while the solids contained in broth of 
beef and mutton were 27 and 33 per cent respectively, that from pork 
contained only 19 per cent. Beaumont found that roasted pork re- 
quired five and one fourth hours for its solution and digestion in the 
stomach. 

Bacon has the following composition, according to Church : 

In 100 parts. In 1 lb. 

oz. gr. 

Water 22"3 3 248 

Nitrogenous matter 8'1 1 130 

Fat 65-2 10 189 

Salt 3-8 256 

Phosphates, etc 0*6 42 

Venison has the following composition (Yon Bibra) : Water, 74*63 ; 
albuminates, 19*24 ; fat, 1*3. When young and tender, it is palatable 
and easily digested, and, although inferior to beef in nutritive value, 
may be a useful addition to the diet of the sick and convalescent. 

The domestic Chicken is a most important article of food for sick 
and convalescents. The taste is agreeable, the tissues soft and easy of 
mastication and digestion. " Spring chickens " are more tender and 
delicate than the fully-developed fowl of four or six months. Xext to 
the chicken in point of digestibility is the domestic turkey, and after 
this the domestic goose and duck. Certain " game-birds," e. g., the 
prairie-chicken, wild-ducks, woodcock, snipe, are frequently prescribed 
for convalescents, and possess a high degree of nutritive value, but 
are not, of course, adapted for habitual use. 

The viscera of certain animals are sometimes employed as food. 
Allusion has already been made to " sweetbreads," the thymus of the 
calf. The pancreas is very often substituted for the true sweetbread, 
and may, when in proper condition, be used instead of the thymus, 
but it is apt to be stringy and fibrous. The brain, tongue, heart, liver, 
kidneys, and alimentary canal, are occasionally eaten, but are not frev 
quently prescribed for the sick. Brain is easily digested, and, as it 
contains fats in combination with phosphorus, may be usefully pre- 
scribed in conditions of disease in which these constituents are pre- 
sumed to be deficient in amount. Liver, as ordinarily prepared by 
frying, is very trying to weak stomachs, but this food contains mat* 



ALIMENTS— ANIMAL. 



33 



ters which may be utilized in certain diseased states. According to 
Braconnot (Pereira), the composition of liver is as follows : 

Brown oil, containing phosphorus 3-89 

Nitrogenous matter. 6*07 

Albumen 20*19 

Salts 1-21 

Water 6864 

Kidneys, especially as ordinarily prepared, are very difficult of 
digestion, and are unsuited for the sick. As they contain a notable 
quantity of urea and other excrementitious matters, they are for this 
reason objectionable articles of diet. Tripe, the stomach of ruminants, 
is very easily digested and very nutritious, when prepared in the sim- 
ple way, only, which is advisable for invalids. It consists largely of 
albumen. 

In order to test the relative value of the animal foods considered 
in the foregoing pages, Marchal de Calvi (Fonssagrives) made a series 
of elaborate examinations to determine the proportion of water and 
fat to the solid. The results were as follow : 



ANIMAL FOODS. 


First Analysis. 


Second Analysis. 


Solid matters. 


Water. 


Solid matters. 


Water. 


Pork 


294-50 

277-00 
265-50 
263-50 
260-00 


705-50 

723-00 
734-50 
736-50 
740-00 


302-50 
275-00 
263-50 
263-00 
255-50 


697-50 


Beef 


725-00 


Mutton 


736-50 


Chicken. ........ 

Veal „ 


737-00- 
744*50 







These analyses assign to pork the first position. In another series 
of experiments M. Marchal used ether to dissolve the fat contained in 
the fibers of these meats. His results are expressed in the following 
figures : 



ANIMAL FOODS. 


Matters soluble in 


ether. 


Matters insoluble fn etb.tr. 


Beef 


25-437 
14070 
59-743 
29-643 

28-743 


249-563 


Chicken 


248930 


Pork 


242-757 


Mutton 


233-857 


Veal 


226-757 







The following is the most recent contribution to our knowledge of 
the composition of these animal foods (Church) : 

The composition of 1 lb. of 





Beef. 


Mutton. 


Pork. 


Veal. 


Lamb. 


Water , 


Oz. Gr. 

8 
1 122 
1 62 
4 340 
350 


Oz. Gr. 

7 16 

385 

1 52 
6 176 
245 


Oz. Gr. 
6 69 

315 
385 
8 
105 


Oz. Gr. 
10 

1 199 

1 82 

2 281 

312 


Oz. Gr. 

8 44 


Albuminoids 


360 


Ossein-like substances .... 
Fat 


400 
5 263 


Mineral matter 


244 



34 RESTORATIVE AGENTS. 

According to these experiments, from the chemical point of view, 
beef has the highest nutritive value ; chicken ranks second, and is but 
little inferior to beef ; while veal is the lowest. 

There are certain substances of animal origin which possess great 
importance as dietetic agents, viz., eggs, and milk and its products. 

Eggs. — The following observations refer to the eggs of the domes- 
tic chicken. The egg is composed of four distinct parts : the shell ; 
the membranous envelope of the albumen ; the white ; the vitellus, or 
the yellow. The envelope of the albumen contains nitrogen and sul- 
phur, and phosphate of lime remains after incineration. The white or 
the albumen contains in 100 parts : 

Albumen 1 2 to 15 

Matter not coagulable 5 

Water 80 

The residue after incineration of the albumen is composed of phos- 
phates and sulphates of lime and magnesia, and alkaline carbonates. 
The yellow is a phosphorated fatty matter suspended in water by 
means of an albuminous substance known as vitellin. The yellow 
contains 53*78 parts of water, 17*47 of albumen, and 28*75 of fatty 
matter. According to Gobley (Fonssagrives, from whom most of 
these details have been obtained), the yellow has the following chemi- 
cal constitution : 

Water 51-486 

Vitellin 15-760 

Margarin and olein 21-304 

Cholesterin 0*438 

Margaric and oleic acids 7226 

Phospho-glyceric acids 1-200 

Sal-ammoniac 0'034 

Salts 7299 

Extracts 400 

Ammonia, nitrogenized matters, coloring matter, lactic acid - 833 

Eggs consumed by the sick should be fresh and sound. The aver- 
age weight is about two ounces avoirdupois. According to Parkes, 
the following are tests of the freshness and soundness of eggs : 

" Fresh eggs are more transparent in the center ; old ones at the 
top. Dissolve one ounce of salt in ten ounces of water : good eggs 
sink, indifferent swim. Bad eggs will float even in pure water." 
Fonssagrives recommends the same tests. Eggs coated with beeswax 
dissolved in warm olive-oil (one third beeswax, two thirds olive-oil) it 
is said may be preserved for two years. 

Eggs raw, or better, whipped, are the most digestible of alimentary 
substances, and, as their composition indicates, possess a very high de- 
gree of nutritive value. 

Milk is one of the most important articles of food for the sick, and 



ALIMENTS— ANIMAL. 35 

enters largely into the composition of various diets. It is constituted 
essentially of four elements — albuminoid, fatty, saccharine, and saline 
— and therefore contains all the materials necessary for the growth 
and nutrition of tissues. The nitrogenous constituent is casein, an 
albuminoid substance, but which differs from ordinary albumen in that 
it is combined with a larger proportion of alkali, and is not coagulable 
by heat. The fatty element is butter, which contains several neutral 
fats. The composition of butter is not exactly the same in all kinds 
of milk, the difference being due chiefly to a volatile principle upon 
which the special taste of each variety depends. The saccharine ele- 
ment is a crystallizable sugar, known as lactin or lactose, a substance 
which easily decomposes into lactic acid by a process of fermentation 
in which the casein plays the part of a ferment. The mineral con- 
stituents of milk are, chlorides of sodium and potassium, phosphates 
of lime, soda, magnesia, and iron. The most important of these is 
the phosphate of lime. The amount of these salts varies from *5 to 
*8, and rarely exceeds one per cent (Parkes). The French commis- 
sion, appointed by the Prefect of Police of Paris, reported upon the 
analysis of milk made in various countries, and concluded that the 
following figures represent the composition of this fluid when of good 
quality (Tardieu) : 

Water 87 

Total solids 13 

Casein, extractive 

matters, and salts. Butter. Lactin. 

Solids 400 4-00 5 

The commission fixed the minimum standard of good milk at — 

Water 88*50 

C Casein, extractives, and salts 4*00 

Solids 11-50 ] Butter 2- 10 to 3'00 

( Lactin 4-50 

When perfectly fresh, milk is usually neutral in reaction, or it may 
be a little alkaline. After a short time — especially in summer — it be- 
comes acid by a process of fermentation in which the lactin is con- 
verted into lactic acid, and the casein coagulates. The fluid portion 
is called whey, and the semi-solid casein curds. By the fermentation of 
mare's-milk an alcoholic liquor, named koumiss, is prepared in Tartary, 
and has been introduced into medical practice as a remedy for phthisis. 

The proportion of cream in good milk ranges from 10 to 15 per 
cent by volume. By churning, the fat of the cream is collected and 
is then known as butter. This important article of food has the fol- 
lowing composition (Fonssagrives) : 

Margarin 68 

Butyrolin 30 

Butyrin, caprin, and caproin . . 2 



36 



RESTORATIVE AGENTS. 



Butter readily undergoes decomposition — becomes rancid — capric 
and butyric acids separating from the base glycerin. This process is 
one of fermentation {butyric), and is due to the action of a special 
organism, the growth of which is favored by air, light, and imperfect 
separation of milk in the process of churning. 

After the process of churning, which separates the butter, the re- 
sultant liquid, known as buttermilk, contains the casein, lactin, and 
the salts, and is therefore a nutritious article of food. 

As the milk of other animals than the cow is sometimes prescribed 
in medical practice, the comparative chemical constitution of this fluid 
should be studied. The following table (Pereira) shows at a glance 
the difference in composition of the milk from several animals : 



CONSTITUENTS. 


Cow. 


As3. 


Goat. 


Woman. 




4-4S 
313 

4*77 

0-60 

87-02 


1-82 
0-11 
6-08 
0-34 
91-65 


4-02 
3-32 
5-28 
0-58 

86-80 


1-52 


Butter 


3"o5 




650 


Salts 


0-45 


Water 


87-98 







Whenever fresh and pure milk can be procured, this only should 
be prescribed for the sick, but in large cities it is not always practica- 
ble to obtain it. Under these circumstances " condensed milk " must 
be used. This preparation is made by evaporation of the water of 
the milk and the addition of some sugar. It is found in two forms, 
dependent on the extent to which the abstraction of water is carried : 
as a granular solid and as a soft semi-solid. The addition of warm 
water to the condensed milk furnishes a palatable fluid, of the appear- 
ance and composition of fresh warm milk. 

Fresh milk, boiled and corked up in bottles to exclude the air, will 
keep for a considerable length of time. To prevent fermentation, some 
sulphite of lime may be added to it. For temporary preservation of 
milk in the summer-time, especially when intended for food for infants, 
a little bicarbonate of soda and sugar may be used. 

Cheese contains all the constituents of milk, except the water and 
some salts and lactin removed by expression. In the preparation of 
cheese the casein of the milk is coagulated by rennet, the butter and 
a portion of the lactin and salts are entangled in the meshes of the 
casein, and the mass is subjected to powerful compression. The pe- 
culiar flavor and quality of the cheese depend upon the nature and 
richness of the milk, and upon certain fermentative changes which take 
place, developing volatile, odorous, and sapid constituents. The follow- 
ing table of the composition of cheese illustrates its nutritive qualities : 

Water 36 . 8 

Albuminates 335 

Fats 24-3 

Salts 5.4 



ALIMENTS— ANIMAL. 3? 

It is evidently a concentrated food. The digestibility of cheese de- 
pends in part on its freshness, in part on its composition. When fresh 
and of good quality, it does not ordinarily disagree with the stomach. 
A small quantity of cheese taken after dessert in some cases assists 
digestion ; but many dyspeptics and persons of weak digestion can 
not make use of it under any circumstances. 

Koumiss. — This is a fluid obtained from mare's-milk by fermenta- 
tion, and constitutes the principal part of the food of the people inhab- 
iting a portion of Tartary. It contains alcohol, lactic acid, sugar, 
casein, fat, salts, carbonic acid, and water. In addition to these con- 
stituents, ascertainable by chemical analysis, koumiss possesses fragrant 
compounds, volatile, the product, probably, of the decomposition of 
the fat and the reaction of the acids on the alcohol, forming ethers. 
Koumiss of good quality may also be prepared from cow's-milk by the 
process of fermentation, but, as mare's-milk is more nearly allied to 
human milk in composition, it is to be preferred in the preparation of 
this aliment. By variations in the method of preparation, different 
kinds of koumiss are produced, as, for example, thick koumiss, whey- 
koumiss, skimmed-koumiss. According to the different stages to 
which the process of fermentation is carried, there result three degrees 
of quality, No. 1, No. 2, and No. 3. No. 2 differs from No. 1 in con- 
taining more alcohol and carbonic acid, and less sugar and casein. 
These constituents, especially the carbonic acid, impart a liveliness to 
the fluid, so that it effervesces like champagne. In No. 3, the fermen- 
tation having proceeded further, butyric, succinic, and acetic acids are 
produced, and the sparkling quality is enhanced. 

Koumiss is prepared from milk, by the addition of a ferment — 
some koumiss obtained from a previous fermentation or dried kou- 
miss. It is allowed to ferment three days at a temperature of from 
70° to 80° Fahr. It is then a bluish-white liquid, having a sharp, 
acidulous taste, and none of the characteristics of ordinary milk. If 
heated to 100° Fahr., fermentation is definitely arrested. If before 
being heated it is bottled, products corresponding to 1, 2, and 3, 
named above, are the result. Allowed to stand after three days' fer- 
mentation, it separates into three layers : the inferior, caseous ; the 
middle, an acid water ; and the uppermost, a whitish fluid, the best 
koumiss. The alcoholic strength is of course determined by the stage 
of fermentation. The koumiss of two days' fermentation is feeble in 
strength, and hence the product of three days' fermentation is prefer- 
able for medicinal use. 

The quantity of koumiss administered depends on the condition of 
the patient. In cases of feeble digestion, this being the only article 
of food, an ounce every hour will be a sufficient quantity. With 
increased facility in its digestion and assimilation, from a quart to 
a gallon a day may be taken: When it is used in connection with 



38 RESTORATIVE AGENTS. 

other food, a tumblerful may be administered after each meal. It 
is estimated that each quart of koumiss contains four ounces of solid 
food. 

The tolerance of the stomach to koumiss is remarkable, even in 
cases of gastralgia. It improves the appetite, and excites the action 
of the kidneys. The patients experience a pleasing exhilaration, due 
probably to the combined action of the carbonic acid and the alcohol. 
Decided intoxication undoubtedly may result from the use of a large 
quantity by any one unaccustomed to it. It also causes somnolence 
during the day, and favors sleep at night without leaving any after- 
headache. Its most important action is the increase of the body 
nutrition ; and hence its utility in the treatment of phthisis, indiges- 
tion, and the various cachexia?. Jagielsky says that he has had pa- 
tients gain as much as ten pounds a month when no other food was 
taken. 

Galazyme and Kefyr. — As the milk of mares and asses can not 
be procured in quantity in this country, it is necessary, if prepara- 
tions like koumiss are to be made, to employ for this purpose the 
milk of cows. Under the name of galazyme, a, fermented liquor 
analogous to koumiss was first proposed by Schneep. This is made 
by the addition to milk of sugar and a ferment, the carbonic acid 
and alcohol being produced by the fermentation of the cane-sugar, 
the lactose of the milk remaining unchanged. The formula he gives 
is as follows : 

To every litre (quart) of milk he adds three parts of cane- and five 
parts of milk-sugar and some brewer's yeast. The mixture is put 
aside in a suitable temperature until the fermentation has reached the 
proper point, care being taken to stop the process before reaching 
the acetic and lactic-acid stage. Deschiens has proposed another 
formula which has some advantages. He employs the yeast now 
made for the manufacture of high-grade alcohols, and mixes one 
drachm of this with two and a half drachms of sugar in some water ; 
this solution is placed in a quart of milk, and the whole is then 
allowed to proceed to the alcoholic fermentation in the ordinary way. 
When the process has reached the proper stage, the galazyme is put 
into strong bottles, the corks fastened in the way the sparkling wines 
are now inclosed. 

A fermented milk analogous to koumiss is prepared in the Cau- 
casus under the name of kefyr. The fermentation is set up in the 
milk by the addition to it of a ferment known as kefyr, which is a 
microbe having peculiar qualities. The microbe ferment of milk — the 
oldium lactis — under appropriate conditions, transforms the lactose or 
sugar of milk into lactic acid ; but kefyr — the dispora caucasica — 
changes it into alcohol and carbonic acid. The difference in composi- 
tion of milk and kefyr has been shown by chemical analysis to consist 



ALIMENTS— ANIMAL. 39 

in a diminution in the kefyr of the albumen, fat, and sugar, and the 
addition of lactic alcohol and carbonic acid. 

The quantity of alcohol in kefyr and galazyme varies from one 
half of one per cent to three per cent, and is determined by the extent 
to which the fermentation has been carried. The amount of car- 
bonic acid, on the presence of which the sparkling character depends, 
is governed by the stage to which the fermentation has gone at the 
time of bottling. When completed and bottled, it presents a milky 
appearance, and on pouring it out from the bottle containing it, effer- 
vesces finely, and is covered with an abundant foam. The taste is 
fresh, slightly acid, and a little pungent, like the ordinary carbonated 
waters. There is probably no difference between koumiss, galazyme, 
and kefyr, in respect to their action on digestion and assimilation, and 
hence the domestic preparation, if properly made, may be substituted 
for the more expensive imported koumiss. 

Fish. — A great many varieties of fish are used as foods to which 
it is necessary to allude in general terms only. Salted fish is not a 
suitable article of food for the sick : it is diificult of digestion, and 
possesses but slight nutritive value. Fresh fish, however, properly 
cooked, is, as a rule, easy of digestion, and furnishes a pabulum of a 
valuable kind in diseases of certain textures. The following is the 
composition of fish as compared with beef, according to the analysis 
of Fr. Schulze : 



CONSTITUENTS. 

Fibrin, cellular tissue, nerves, and vessels 

Albumen 

Alcoholic extract and salts 

Aqueous extract and salts 

Phosphates 

Fats and loss 

Water 



15-0 


12-0 


4-3 


5-2 


13 


1-0 


1-6 


IT 


traces. 


traces. 


1-0 


" 


11'S 


80-1 



The commonly-received opinion, that fish is a more highly -phospho- 
rated food than beef, does not receive support in this analysis. White- 
fish, shad, bass, and fresh mackerel, are more suitable for the sick than 
cod, salmon, or eels. They should be prepared and eaten as soon as 
possible after being taken from the water, and should be either broiled 
or boiled. Only at the time of the ripening of the milt and roe are 
fish in a suitable condition for the dietary of invalids. At the time 
of spawning, and immediately after, the flesh of fish is watery and 
semi-gelatinous. 

Oysters rank among the most digestible of foods, and are usually 
easily borne by the most delicate stomach. According to Fonssagrives 
the French oyster contains about 12*6 parts of solid matters, consist- 
ing of osmazome, chlorides of sodium and magnesium, sulphates of 
lime and magnesia, fibrin, albumen, and gelatin. They are more easily 



40 RESTORATIVE AGENTS. 

and quickly digested when eaten raw, or broiled, but stewed is the 
most common form for use in disease. In cases of great irritability 
of the stomach, the most easily borne oyster-soup is prepared by the 
addition of the liquor to boiling milk. 

Vegetable. — The most important members of this class of foods 
are the cereal grains — wheat, rye, corn, rice, buckwheat, oats, and bar- 
ley. The universality of its consumption and its nutritive value place 
wheat-bread in the first position as an article of diet. The composi- 
tion of wheat-Hour is as follows : 

Water 140 

Fatty matters 1*2 

Gluten 12-8 

Albumen , T8 

Dextrin, sugar 7"2 

Starch 59"7 

Cellulose T7 

Salts (potash, soda, lime, magnesia, phosphoric acid, etc.) 1*6 

In the preparation of wheat-flour, the bran is separated. Important 
constituents of the wheat are thus removed, as the following analysis 
of the bran shows : 

Water 103 

Fatty matters 2 82 

Gluten 10-84 

Albumen 1'64 

Dextrin, sugar 5'8 

Starch 22'62 

Cellulose 4398 

Salts .' 2-52 

The internal envelope of the wheat-grain contains also a ferment, 
know as cerealin, which has very active properties. As the propor- 
tion of bran to flour is as sixteen to eighty, it is obvious that consider- 
able loss accrues in the preparation of superfine flour. Wheat-bread 
made from superfine flour is easy of digestion, owing to its lightness 
and sponginess permitting a rapid diffusion of the gastric juices through 
every part of it. Most of it is also available for nutrition ; there is 
little residuum ; hence the constipation which attends its use in large 
proportion relatively to the other constituents of the diet. When 
flour is unbolted (bran not separated), an increase of nutritive value is 
obtained, at the expense, however, of digestibility. A large part of 
the bran, probably, resists the action of the gastric juice, and hence, 
irritating the mucous membrane, increases by reflex action the secre- 
tions and peristaltic movements. 

Whole wheat-grains, under the name of " cracked wheat" is fre- 
quently prescribed as an article of diet for invalids. It is boiled until 



ALIMENTS— VEGETABLE. 41 

the envelope of the grain is burst open, and is eaten with cream and 
sugar. Obviously such a combination forms a food of great excel- 
lence. The special advantage which it possesses, besides its nutritive 
value, is its laxative action. 

Ordinarily, wheat-bread made of superfine flour is to be preferred 
for the use of invalids. To obviate the constipating action of such 
bread, and to obtain a laxative effect, various expedients are adopted. 
Bran, rye, and corn meal, and, in some kinds of bread, molasses, are 
added to the dough, forming those varieties known as Graham bread, 
brown bread, and Boston brown bread. 

The important quality of lightness is imparted to wheat-bread by 
thorough incorporation of carbonic-acid gas with the dough. Two 
processes are employed for this purpose : By the addition of yeast, 
fermentation takes place at the expense of a portion of the starch, and 
carbonic acid and alcohol are produced. By mechanical means, car- 
bonic acid obtained from other sources is mixed with the flour. The 
latter is known as " aerated bread." Obviously, the mechanical pro- 
cess is more economical because there is no loss of flour. It furnishes 
usually a lighter and drier bread, and is more easily digested. Bread 
made by the fermentation process is not unfrequently moist and heavy, 
and sour, because the fermentation has proceeded beyond the alcoholic 
stage. " French bread " is lighter, drier, and better baked, than ordi- 
nary baker's fermented bread. Warm, fresh bread is not suitable for 
invalids. It can not be so perfectly masticated as older bread, and, 
not reaching the stomach in a state to permit diffusion through the 
mass of the gastric juices, lies unchanged for hours. 

According to Smith, the ultimate composition of wheat-bread is 
as follows : 

Water 37-0 

Starch 4Y'4 

Sugar 3-6 

Fat 1-6 

Salts. 2 3 

Macaroni stewed in milk is sometimes prescribed for the sick. 
Prepared with butter, cheese, and condiments, it is not an appropriate 
food for invalids. In composition it consists chiefly of gluten, and of 
course starch — but in less proportion than in bread — and of fat. The 
cylindrical tubes in which it occurs are formed by passing the paste 
of flour (gluten) through perforated plates. 

Bread requires from three and a half to four hours for complete 
digestion. Brown bread digests somewhat more slowly. 

Barley is but rarely used as food in this country. It is occasionally 
prescribed for the sick in the form of infusion — a demulcent drink — 
and is frequently added to soup. It has the following composition 
(Smith) : 



42 RESTORATIVE AGENTS. 

Water 150 

Starch 69'4 

Sugar 4"9 

Fat 24 

Salts 2-0 

Albuminous substances 6 3 

Rice is one of the most digestible of vegetable foods, requiring, 
when boiled, about one hour. Its nutritive value is not equal to 
wheat, because it consists chiefly of starch. The following is its 
proximate constitution: 

Water 13'0 

Nitrogenous matter 6 - 3 

Starch T9'l 

Sugar - 4 

Fat 0-7 

Salts 05 

Rice-water, or decoction of rice, like the corresponding preparation 
of barley, is used as a demulcent drink in fevers and intestinal disor- 
ders. Boiled rice is frequently prescribed as a diet for invalids with 
weak digestion, and is enriched by the addition of milk and cream, 
and eggs (rice-pudding). 

A comparison of its chemical composition with that of wheat or 
corn will show that it is by no means equal to them in nutritive value. 
It is obviously unfitted to sustain life alone, and hence in rice-eating 
countries it is mixed with fat or other foods supplying principles in 
which it is deficient. 

Corn has the following composition (Letheby, Smith) : 

Water 14*0 

Nitrogenous matter (albumen) ll'O 

Starch 64*7 

Sugar 0*4 

Fat 81 

Salts VI 

It is not so readily digested as starch, requiring about three hours. 
Corn, when green, is prepared for the table by boiling, and is eaten 
with salt and butter, or milk. If young and tender, and sufficiently 
cooked, it is a digestible and nutritious food ; but, if the grain is too 
mature, it resists the action of the intestinal juices, and passes un= 
changed. 

The mature grain, deprived of the heart and husk, is known as 
hominy. Thus prepared and thoroughly boiled it is an esteemed 
article of diet, ranking in nutritive value a little above boiled starch. 
Mush is boiled corn-meal, which may be eaten with milk, and is some- 
times fried, but in that form is highly objectionable. Corn-meal is also 
eaten in the form of bread and cakes. These various preparations of 



ALIMENTS— VEGETABLE. 43 

corn are liable to cause intestinal disorders, and hence are improper 
in cases of irritable mucous membrane, and in diarrhceal diseases. 
For this reason corn-bread is sometimes prescribed in cases of con- 
stipation dependent on diminished secretion of the intestinal mucous 
membrane, and torpor of the muscular layer of the bowel. The 
starch of corn is not unfrequently prepared for invalids in the form 
of blanc-mange. 

Oatmeal corresponds in physical qualities and composition to 
corn-meal. Its proximate composition, according to Smith, is as 
follows : 

Water 15*0 

Nitrogenous matter 12*6 

Starch 58*4 

Sugar 5'4 

Fat 5-6 

Salts 30 

It is not at all generally used as an article of diet in this country. 
It is prescribed in the form of gruel as a delicate food. Boiled for 
a long time, the oatmeal swells up and thickens, forming a blanc- 
mange, which may be eaten with milk, or butter, or cream, and sugar 
and aromatics. 

Buckwheat flour is largely consumed in this country, chiefly in 
the form of breakfast-cakes. As it contains a relatively small propor- 
tion of starch, and considerably more fat and salts than wheat flour, 
it can be eaten by diabetics in the form of light bread, and is said to 
be preferable to any gluten preparation. 

The Potato, next to wheat, is the most important food derived 
from the vegetable kingdom. Its composition is affected by its 
source and variety, and by the soil in which it is grown. The 
specific gravity of the potato affords an index of its nutritive 
value, for, the heavier, the greater the quantity of starch it contains. 
For the sick, watery potatoes are unsuitable. When cooked, the 
tuber should be mealy and dry. The following is the composition 
of the potato : 

Water 75-0 

Nitrogenous matter 2*1 

Starch 18*8 

Sugar 3-2 

Fat 0-2 

Salts 0-7 

According to some authorities, the potato contains free citric acid. 
The salts are rich in potash. According to Letheby, the composition 
of the sweet-potato is nearly that of the white, the chief difference 
being the proportion of sugar, which is three times greater than in 
the latter. 



44 



RESTORATIVE AGENTS. 



Starch, Sago, Arrowroot, and Tapioca, differ from the preceding 
vegetable foods in that they contain no nitrogen. They are digested 
in from one to two hours. They are largely used in the preparation 
of diets for the sick, but are insufficient in themselves to maintain for 
any considerable period the vital functions. Hence they are prepared 
and eaten with sugar, milk, cream, butter, and aromatics. 

7\imips, Parsnips, Carrots, Onions, Asparagus, Beets, Cauliflower, 
Cabbages, and Celery, are but rarely prescribed for the sick, but enter 
into certain special plans of diet. According to Smith, the following 
represents the composition of 



Turnips. 


Carrots. 


Parsnips. 


Water 

Sugar 


1 91-0 

. 2-1 
. 1-2 

.' 5-1 
. 0-6 


Water 


. 83 
. 6-1 
. 1-3 
. 0-2 
. 8-4 
. 1-0 


Water 

Sugar. . . 

Nitrogenous matter. . 

Fat 

Starch 

Salts 


. 82-0 
. 5-8 


Nitrogenous matter. . 

Fat. 

Starch 

Salts 


Nitrogenous matter . 

Fat 

Starch 

Salts ' 


. 1-1 

. 0-5 
. 9-6 
. 1-0 









Beets differ from the above chiefly in the quantity of sugar. The 
following is the analysis of Payen : 

Water 83*5 Nitrogenous matter To 

Sugar 10-5 Pectose, etc 8 

Salts and pecten 3 7 

All of the members of this group are deficient in nutritive value, 
and are besides slow and difficult of digestion, requiring from three to 
five hours for complete solution. 

Ripe fruits, as grapes, apples, pears, peaches, oranges, lemons, etc., 
possess but little nutritive value, as they contain only about 10 to 15 
per cent of solid matters. In composition they are represented by 
sugar, free acid (tartaric, citric, etc.), nitrogenous matters, and salts. 
They differ, of course, in the peculiar flavoring matters which give to 
each fruit its special taste. Dried fruits, as dates, figs, and raisins, are 
relatively much more nutritive, because they contain a larger percent- 
age of sugar. Under the head of dietetic management of diseased 
states, some further remarks will be made on the use of the fresh and 
dried fruits. 

SPECIAL PLANS OF DIET. 

The food-supplies to the organism may be so managed as to secure 
very definite therapeutical results. By increasing or diminishing the 
whole amount of foods ingested, by variations in the quality and char- 
acter of them, and by the employment of some special and restricted 
methods of feeding, cures are effected not attainable by medicinal 
treatment. 

Denutritiox. — The amount of food necessary for bare subsistence 
has been pretty accurately determined. During the siege of Paris the 



DENUTRITION. 45 

daily ration was at one time reduced to less than ten ounces of bread 
and one ounce of meat daily. Dr. Edward Smith ascertained that the 
daily amount of food barely sufficient to maintain life among the fac- 
tory operatives must contain 2*84 ounces of nitrogenous matter, and 
19*25 ounces of carbonaceous. Pettenkofer and Voit give, as the 
necessary amount of food required by an adult when at work, 5*22 
ounces of nitrogenous and 22*38 of carbonaceous matter. Letheby 
furnishes the following table as the result of his investigations on 
this point : 

Nitrogenous, Carbonaceous, 

Daily diet for ozs. ozs. 

Idleness 2-67 19'61 

Ordinary labor 4-56 2924 

Activelabor 5"31 34*97 

The ration of the United States soldiers imprisoned at Andersonville 
consisted of one third pound of bacon and one pound and a quarter of 
unbolted corn-meal. This amount and quality of food were insufficient 
to maintain the bodily functions in a healthy state, and hence vast 
numbers died of scorbutus, diarrhoea and dysentery, and hospital gan^ 
grene. From these data we are enabled to form an estimate of the 
amount and kind of food necessary to maintain life in those cases of 
disease in which it is desirable to apply the method of denutrition. 

Physiological Effects of Insufficieyit Food. — Intestinal uneasiness, 
more or less pain, borborygmi, and a feeling of hunger, are among the 
first symptoms of an insufficient supply of food. The secretions of the 
intestinal canal diminish, digestion becomes difficult, and constipation 
results. The respiratory movements are diminished in frequency and 
volume, and the exhalation of carbonic acid notably declines. Ac- 
cording to Dr. Edward Smith, while under an ordinary diet the daily 
excretion of carbonic acid amounts to thirty-four ounces, under an 
almost complete abstinence it falls in twenty-four hours to twenty-two 
ounces. The blood suffers a notable diminution in its amount ; the 
quantity of water augments, and the number of blood-globules greatly 
diminishes. Meanwhile the blood loses its plasticity, and a tendency 
to hemorrhagic extravasations is developed. The urinary secretion 
also lessens in amount ; the urea and uric acid dimmish, but the hip- 
puric acid rather increases ; the chlorides after some days almost dis- 
appear, but the sulphuric and the phosphoric acids persist. As a re- 
sult of the very obvious decline in the function of assimilation, the 
temperature of the body falls some degrees below the normal. The 
functions of the nervous centers undergo a marked derangement. 
Giddiness, vertigo, hallucinations, ensue, and are coincident with a 
fatty degeneration of the cells of the gray matter. The subcutaneous 
fat disappears ; the muscles lose a considerable part of their substance. 
The muscular substance of the heart diminishes proportionally. The 



46 RESTORATIVE AGENTS. 

bones do not suffer much loss. The extreme degree of loss attainable 
with safety is from 40 to 50 per cent of the average weight. 

Therapy* — Diminution in the gross amount of aliment and a rear- 
rangement of its constituents are of the first importance in the treat- 
ment of obesity. The tendency to obesity may be hereditary or ac- 
quired. In the former it is cured with difficulty ; in the latter a suit- 
able regimen will accomplish much. The fat accumulates under the 
skin, in the visceral cavities, and in the interstices of organs. Two 
doctrines have been held by physiologists with regard to the mode of 
production of fat in the organism : one, that the fat received in the 
food is simply stored up ; the other, that it is also produced by the 
transformation of some of the other constituents of the food. If the 
first theory contained the whole truth, it would be necessary only in 
the treatment of obesity to withdraw from the patient's aliment all 
fatty substances ; but it is found in practice that this is insufficient, 
and that fat is created out of the starchy and saccharine elements of 
the food. Hence it is necessary in the treatment of corpulence to in- 
terdict not only fats, bat the starches and sugar. This was the method 
of Hippocrates ; but it has been revived in our generation by Mr. 
Banting, and is now usually called JBantingism. As a guide to this 
method of treatment I quote the rules of Mr. Banting : 

" For breakfast, at 9 a. m., I take five or six ounces of beef, mutton, 
kidneys, broiled fish, or cold meat of any kind except pork or veal ; a 
large cup of tea or coffee, without milk or sugar ; a little biscuit or 
one ounce of dry toast ; making together six ounces of solid and nine 
of liquid. For dinner, at 2 p. m., five or six ounces of any fish except 
salmon, herring, or eels ; any meat except pork or veal ; any vegetable 
except potato, parsnip, beet, turnip, or carrot ; one ounce of dry toast ; 
fruit out of a pudding not sweetened ; any kind of poultry or game, 
and two or three glasses of good claret, sherry, or madeira — cham- 
pagne, port, and beer, forbidden ; making together ten or twelve 
ounces solid and ten liquid. For tea, at 6 p. m., two or three ounces 
of cooked fruit, a rusk or two, and a cup of tea without milk or sugar ; 
making together two to four ounces solid and nine liquid. For sup- 
per, at 9 p. m., three or four ounces of meat or fish, similar to dinner, 
with a glass or two of claret or sherry and water, making together 
four ounces solid and seven liquid." 

Sugar, Mr. Banting finds, is one of the most active of fat-forming 
foods. His method consists in the avoidance of sugar, fat, and farina- 
ceous substances — in fact, all roots or vegetables grown underground. 
Although this system was pursued by Mr. Banting with success, it 
can not always be persisted in without danger. The dietary is want- 
ing in the amount both of carbonaceous and nitrogenous constituents 
necessary to the healthy action of the organism. Therapeutically it is 
adapted to the end in view — the denutrition of the body ; but it is, 



DRY DIET. 47 

physiologically considered, unsafe to be long persisted in, because in- 
sufficient for the work of the body. 

Aneurism. — A low diet, with absolute rest, is of great value in the 
treatment of internal aneurisms. The diet should be only sufficient to 
maintain life. The method of Valsalva consisted in such a diet and 
frequent and free bleedings, with rest. Mr. Tufnell's plan of diet, 
which has proved very satisfactory in this disease, consists in two 
ounces of liquid and four ounces of solid food morning and evening, 
and four ounces of liquids and six ounces of solids at noon, and with 
this dietary is associated absolute repose in the recumbent posture. 

To diminish the Volume of the Foetus in cases of Dystocia has 
been suggested by Merriman, Baudelocque, and Moreau, and was suc- 
cessfully practiced in two cases by Depaul. The method consists in 
free abstraction of blood, and the lowest diet consistent with the exist- 
ence of life. At the present time the methods of inducing premature 
labor have been so perfected as to quite take the place of the practice 
of Depaul. 

Syphilis. — It is certainly an eminently rational expedient to relieve 
the organism of a virus by a continuous and gradual molecular de- 
struction and a renewal of the anatomical elements. Such is the hun- 
ger-cure of syphilis, an Arabic method of treating that disease. Very 
satisfactory results have been attained by this means ; but the self- 
denial and even suffering which it requires render it exceedingly un- 
popular with patients. 

Dry Diet. — This consists in a decided diminution or a temporary 
total suspension of liquid of all kinds. It is well known that water 
constitutes about two thirds of the gross weight of the adult body. 
The quantity of water daily lost from the body has been estimated at 
about four and a half pounds. Dalton thinks that fifty-two fluid- 
ounces is the quantity required by a man in full health exercising in 
the open air. The difference between this and the amount of loss is 
made up by the water contained in food, especially in the succulent 
vegetables. Indeed, it is quite possible for the vegetarian, whose diet 
consists of fruits and vegetables, to receive sufficient water in this way 
for the purposes of his organism. 

Physiological Effects of Dry Diet. — Besides the tormenting sensa- 
tion of thirst, the food is swallowed with difficulty and the appetite is 
lost. Absorption of the interstitial fluids takes place, and the volume 
of the organs undergoes diminution. The subcutaneous veins flatten, 
and the pulse loses in tension and amplitude ; the saliva becomes vis- 
cid ; the urine reddens and deposits a sediment ; constipation ensues, 
and a rapid emaciation takes place (Fonssagrives). 

Therapy. — As the withdrawal or decided diminution of fluid causes 
rapid absorption of the interstitial water, this method of treatment 
may be resorted to with advantage in cases of dropsy. It has been 



48 RESTORATIVE AGEXTS. 

used with success in dropsical accumulations of the serous cavities, 
and is adapted to the treatment of hydrothorax, hydrops pericardii, 
and ascites. 

Fonssagrives reports two cases of diabetes insipidus (polyuria) de- 
cidedly benefited by the dry diet. This method of treatment is indi- 
cated in diahtcs mellitics, in inflammatory affections, and in fevers — 
for it has been shown that the febrile temperature is in proportion to 
the amount of water furnished the tissues. 

Dilatation of the Stomach, besides other appropriate treatment, is 
benefited by water-free food. That form of dyspepsia and dilatation 
of the stomach produced by excessive beer-drinking is much improved 
by abstinence from drinks of all kinds. The ice-icater dyspepsia, a 
malady quite common during the summer months of this country, may 
be entirely relieved by dry diet. 

Vegetable Diet. — The special indications for the use of vegeta- 
ble food are reserved for the sections on diet in special diseases. It is 
necessary, however, to say something here of the grape-cure, a method 
of treatment much in vogue in some parts of France and Germany. 

The grape-care consists, according to Carriere, of a diet exclusively 
of grapes. They are taken many times a day to repletion. It is usual 
to commence with a pound, and progressively to increase the amount 
to two, three, six, and eight pounds, a limit which is not exceeded. 
The first grape-repast, which may be the most abundant, is in the early 
morning, but not as are the others, eaten in the vineyard. Another is 
taken at the time of the morning meal (corresponding to our break- 
fast) ; the next after the morning walk at the time of the dejeuner 
(noon), consisting of bread and water ; another before the usual din- 
ner-hour (evening), and finally before retiring. The treatment is con- 
tinued during the five or six weeks of the duration of the grape-crop. 

The grape-cure is used with success in plethora of the portal circu- 
lation, diarrhoea, dysentery, hcemorrhoids, and engorgement of the 
spleen. It renders much service in the principal dyscrasiae, as scrofula, 
tuberculosis, and phthisis, gout, and cutaneous diseases (Carriere). The 
influence of change of air, of new scenery, and of the hygienic rules 
enforced at these resorts, should not be ignored in an estimate of the 
value of this method. 

The composition of the ripe grape is, according to Smith, as follows : 



Soluble. 

Grape-sugar 13*8 

Tartaric acid 1*12 

Nitrogenous matter '8 

Gum, fat, etc *5 

Salts -36 

Water 798 



Insoluble. 

Skirts, stones, etc 2*6 

Pectose "9 

Mineral water '12 



The quantity of nitrogenous matter is insufficient for the needs of the 



ANIMAL DIET. 49 

organism, hence the addition of bread and water to the diet of the 
grape-cure. 

Animal Diet. — The more or less exclusive use of animal food im- 
proves the quality of the blood by increasing the number of the red 
corpuscles. The urine rises in specific gravity, and the urea and uric 
acid are increased in amount. According to Liebig, force in excess is 
developed from a diet of animal food, whence a nation of animal feed- 
ers must be a nation of hunters, possessing a savage disposition. 
Those who consume largely of animal food are not fat, but have a 
high degree of muscular activity. They are tormented by imperious 
venereal desires, and are irritable in temper. 

Therapy. — A diet of animal food is specially indicated and of great 
utility in diabetes. As the vegetables and fruits contain sugar, and 
starch which is readily transformed into sugar, they are interdicted in 
this disease. A method of treating diarrhoea long practiced in Rus- 
sia, and popularized by Trousseau, consists in the use of a pulp of raw 
meat. A bit of fillet of beef is deprived of all fat and aponeurotic 
fiber, minutely divided, and beaten in a mortar until all traces of fibers 
have disappeared. It is then pressed through a fine sieve and mixed 
with sugar, conserve of roses, or suitable aromatics, or seasoned with 
salt and pepper to the taste. It may be administered in this form 
with fruit-jelly, or spread on thin pieces of bread. A beefsteak has- 
tily broiled on a hot fire, so as to retain its juices, may be treated by 
the same method, or the raw beef scraped to a pulp, rejecting the 
fiber, may be thrown on to a hot skillet for a few seconds to give an 
odor and appearance of cooked meat. This method, which has been 
used especially in the treatment of diarrhoeal diseases of early life, is 
equally efficacious in the chronic diarrhoea of adults. The chief ob- 
jection to this mode of alimentation is the great frequency with which 
tape- worm follows. 

In states of debility arising from any cause in which it is neces- 
sary to supply an easily-digested nitrogenous aliment, raw beef may 
be used in this way. 

Blood is so rich in the elements of nutrition that its employment 
as a food in wasting diseases need not excite surprise. Within a few 
years it has been much used in the treatment of phthisis, the patients 
resorting to the butchers' shambles to quaff the blood as it flows away. 
On the part of the patients, it is supposed to possess some special cura- 
tive power ; but it is only as a nutrient that its use is justifiable. Be- 
sides the unpleasant associations which must necessarily be connected 
with blood-drinking, there is danger of swallowing parasites. That 
it improves nutrition, often to a remarkable extent, is undeniable. It 
must therefore remain a question to be decided by the patient whether 
he will incur the risk of infection by parasites, to be benefited by 
drinking a valuable nutrient. 
5 



50 RESTORATIVE AGENTS. 

As the serum of the blood contains the most important of the nu- 
tritive elements of the blood, the use of this has been proposed in lieu 
of the latter, administering one ounce three times a day. Blood-serum 
is said to be an efficient vermifuge. It must be taken fasting. 

Milk-Diet. — The numerous and important applications of milk- 
diet in the treatment of certain forms of disease render it necessary to 
devote considerable space to the consideration of this subject. Milk 
is a food already prepared, and therefore needs no intervention of un- 
skillful cooks ; it can be obtained everywhere ; few patients are dis- 
inclined to take it. 

Physiological Effects of Milk-Diet. — In the use of a diet for a long 
time exclusively of milk, great difficulty is often experienced in over- 
coming the repugnance of the patient. Although as a rule it is taken 
with readiness at first, after a time it begins to pall upon the appetite, 
and the greatest resolution is necessary on the part of the patient in 
order to continue it. A distressing sense of emptiness is experienced 
at the epigastrium. The mouth becomes pasty, and the tongue is 
coated with a thick, whitish fur. Constipation, sometimes exceedingly 
obstinate, occurs, and the stools are hard and of an ochre-yellow color. 
Occasionally diarrhoea is produced, but this is due to the fact that the 
milk disagrees and is not digested. The urinary secretion is increased 
in amount, but this is due simply to an increased flow of water. Al- 
though milk contains all the constituents necessary for the nutrition 
of the body, when it is used as an exclusive article of diet in the case 
of those accustomed to a full mixed diet, a decided diminution in the 
weight of the body takes place. After a time, however, the waste 
ceases, and the weight continues at a uniform level. The interference 
of a milk-diet with nutrition is more decided when skimmed milk is 
used — a form in which it is more usually administered in intestinal 
disorders. The pulse is quickened and the arterial tension lowered ; 
but a fall in the pulse-rate takes place when the body ceases to lose 
weight. A marked degree of debility is experienced by some persons, 
so that they are unable to take exercise. In two cases in which I used 
this method with signal success — chronic eczema, and chronic ulcer of 
the stomach — the patients, both females, experienced vertigo and faint- 
ness, and Mitchell mentions a case in which from the same cause he 
was compelled to discontinue the milk. Ordinarily, however, nothing 
more than weakness is experienced. 

Therapy. — Pecholier, Carel, Mitchell, and all who have treated of 
the milk-cure, insist upon the suspension of all other food and drink. 
The quantity to be taken will vary with the constitutional peculiarities, 
habits of life, and probably the mental condition of the patient. As 
milk requires about three hours for its complete digestion, this fur- 
nishes a rule for its administration. One gill, or four ounces, every 
three hours, beginning on rising in the morning, is the rule which I 



MILK-DIET. 51 

have followed with success. As soon as the patient can take a suffi- 
cient quantity, one or two tumblerfuls four times a day may be ordered. 
From a quart to two quarts is the daily amount which will be taken 
usually by the patient. It is better administered slightly warm. 

In many cases of stomach and intestinal disorders, it is better to 
give skimmed milk. The milk should stand for twenty-four hours in 
a cool place, and then all the cream which has risen should be care- 
fully removed. Sometimes, says Pecholier, when crude milk disagrees 
with or is disgusting to the patient, it may be boiled. The digestion 
of the milk, says the same authority, when it is poorly borne, may be 
aided by the addition of lime-water, bicarbonate of soda, and other 
alkalies. Mitchell has added lime-water for the first few days under 
the same circumstances, and, in order to overcome the patient's repug- 
nance to the taste, has faintly flavored the milk with a little coffee 
or caramel ; but he prefers to give it alone as soon as possible. My 
own observation has been, that milk is better borne when given for 
the first few days with lime-water, in proportion of one fourth of the 
latter. 

For the nourishment of infants deprived of their natural food, no 
substitute is better than cow's-milk diluted with about one third of 
water and sweetened with sugar, in order more closely to assimilate it 
in composition to the human milk. This should be given at a tem- 
perature of 100° Fahr., and at intervals of three hours. No other 
food than milk is proper for infants up to the eighth month of life, for 
their digestive organs are not adapted to the digestion of the farina- 
ceous foods so commonly supplied them. If the milk be rejected, the 
addition of lime-water may enable the infant to retain and digest it. 

In the treatment of disease in the adult with skimmed milk, the 
time for suspension of the diet depends on several conditions. Carel 
begins to make additions after two or three weeks ; Pecholier when 
the effects sought for in the treatment are obtained. Mitchell formu- 
lates his method as follows : " My own rule, founded on considerable 
experience, is this : Dating from the time when the patient begins to 
take milk alone, I wish three weeks to elapse before anything be used 
save milk. After the first week of the period, I direct that the milk 
be taken in just as large amount as the person desires, but not allow- 
ing it to fall below a limit which, for me, is determined in each case 
by his ceasing to lose weight. Twenty-one days of absolute milk-diet 
having passed, with such exception as I shall presently mention, I now 
give a thin slice of stale white bread thrice a day. After another 
week I allow rice once a day — about two tablespoonfuls — or a little 
arrow-root, or both, as circumstances may dictate. At the fifth week 
I give a chop once a day ; and, in a day or two, another at breakfast ; 
and after the sixth week I expect to return gradually to a diet which 
should still consist largely of milk for some months." My own rule 



52 RESTORATIVE AGENTS. 

has consisted in the gradual addition of other diet after the cessation 
of symptoms for which the milk-treatment was instituted. 

Dr. Stanley S. Cornell, of Ontario, Canada, has favored me with an 
account of a case of fecal impaction, in which a great quantity of curds 
accumulated behind the fseces. Such an accident illustrates the neces- 
sity of keeping the bowels in good condition during a course of milk 
diet. One of the Saratoga waters, a little Epsom or Rochelle salts in 
the early morning, or a little aloes and belladonna at night, will usually 
suffice. A little black coffee added to the milk may answer. 

The milk-cure is especially adapted to the treatment of obstinate 
stomach affections. It has succeeded admirably in the treatment of 
dyspepsia, gastric catarrh, gastralgia, gastric ulcer, and has procured 
marked amelioration in cases of scirrhus of the stomach. In chronic in- 
testinal indigestion, obstinate and persistent enteralgia, chronic diar- 
rhoea, and dysentery, it has proved very efficacious. 

The treatment of ascites by a milk-diet appears to have been of an- 
cient origin, for Hippocrates distinctly refers to it, but the revival of the 
practice in modern times is due to Chrestian, of Montpellier, who demon- 
strated the utility of this practice in a number of cases (Fonssagrives). 
Pecholier and Chairon also report cases of success treated by this 
method. In cases of ascites the result appears to be due to the profuse 
alvine and urinary discharges which are caused by the milk-diet in this 
disease. Pecholier also reports cases of general anasarca due to cardiac 
disease, much benefited by this treatment. In England, Donkin has 
issued a monograph on the skim-milk treatment of albuminuria, with 
successful cases. This method has also been extended to diabetes, and 
reports of cures are not wanting. 

Eczema, connected with acid indigestion, has been successfully 
treated by an exclusive skim-milk diet in my hands, and Mitchell reports 
an analogous case. Gout and gouty affections have also been much 
improved, and the diathesis apparently removed, by a persistent use of 
the milk-cure. Lastly, aneurism and cardiac disease (irregular and 
tumultuous action due to valvular lesions) have been benefited by a 
milk-regimen. 

Whey-Cure. — This mode of treatment is conducted in the moun- 
tain health-resorts of Switzerland and Germany, and is usually connected 
with the grape-cure. As whey contains so little of the nutritious ele- 
ments of the milk, we may conclude with Lebert that the hygiene and 
climate of these mountain-resorts do everything for the patients, and if 
they improve they do so in spite of the whey. 

Koumiss-Cuee. — Koumiss differs from whey in containing the nutri- 
tive constituents of milk, and from milk itself in the important respect 
that it is in addition an effervescing alcoholic fluid. Koumiss possesses 
great value in the treatment of phthisis, chronic bronchitis, the low 
stage of fevers, the stage of convalescence from acute diseases, and in 



BUTTERMILK-CURE. 



53 



fact in all adynamic states in which the combined effect of alcohol and 
nutrients may be desirable. 

Buttermilk-Cure. — To the efforts of Dr. Ballot, of Rotterdam, is 
due the knowledge we now possess of the value of buttermilk as a food 
for infants. The relative composition of buttermilk and mother's-milk 
is given in the following table : 



CONSTITUENTS. 


Buttermilk. 


Mother's-milk. 


Casein 


43-8 

236 

2-0 

5-6 

921-75 

78-25 

2-75 


34-3 


Milk-sugar 


482 




23-3 


Salts 


23 




883-6 


Total solids 


116-4 




nil. 







It is probably in consequence of the presence of lactic acid, as Dr. Ballot 
suggests, that buttermilk is easily digested. His manner of preparing 
the food for infants is as follows : To a pint of buttermilk is added a 
spoonful of wheat-flour. This is boiled a few minutes. The pap must 
be thin. To this quantity of buttermilk, after it is boiled, is added half 
a drachm of sugar. It should have a sweet taste. 

In the beginning some teaspoonf uls are given to habituate the infant 
to the smell and taste, but as soon as possible it should be administered 
in a nursing-bottle. The temperature should be about 96° Fahr. When 
the infant acquires a taste for the preparation, it may be given ad libi- 
tum twice a day. 

Buttermilk-cure may be substituted for the milk-cure in cases of 
stomach disease, in which the former has proved so successful, and in 
cases of albuminuria and diabetes. In consequence of the large propor- 
tion of lactic acid which it contains, buttermilk is more especially indi- 
cated in diabetes. 

Infant-Feeding. — It has already been stated that fresh milk of the 
cow is the best substitute for the mother's-milk. Some additional obser- 
vations as to the management of cow's-milk, and as to the substitutes 
therefor, may, however, be necessary. There can be no doubt that cow's- 
milk is better than goats' or asses' as a rule, although there are infants 
who thrive on the two last-named better. In the large cities where it 
is impossible to procure fresh milk, condensed milk is an efficient sub- 
stitute. As in the preparation of this the temperature is raised to near 
the boiling-point of water, it undergoes no change, and can be used 
when fresh milk is not to be procured, or can not be preserved. Con- 
densed milk is ready for use by mixing it with water in the proportion 
of one teaspoonf ul of milk to seven of warm water. When the addition 
of lime-water is desirable, it can be added in proper proportion. In the 
author's experience, children, with few exceptions, do well on condensed 
milk. 



54 RESTORATIVE AGENTS. 

Casein is that constituent of milk which is most likely to disagree 
with infants. Dilution with water, lime-water, barley-water, etc., is 
not unfrequently effective in securing the digestion and absorption of 
the casein ; but some infants are unable to digest it at all. Various 
expedients are resorted to when the casein fails entirely of digestion. 
Cream diluted with barley-water sometimes succeeds extremely well. 
The indigestion of the casein of a given specimen of milk may be 
due to an insufficient quantity of cream ; this defect can be obviated 
by adding it artificially. When the infant is not nourished suffi- 
ciently, and yet does not pass undigested casein, the proportion of 
cream is probably too low. To assist the digestion of casein, Jacobi 
recommends that a little well-sweetened oatmeal-gruel be given the 
infant before taking the bottle, or be mixed with the milk. His 
method of preparing the food is as follows : 

" A teaspoonf ul of either oatmeal or barley is boiled in from three 
to six ounces of water, with some salt, for twelve or fifteen minutes, 
the decoction to be quite thin for very young infants, thicker for 
later months, and then strained through a linen cloth. Infants of 
four or six months are to have equal parts of this decoction, which 
ought to be made fresh for every meal ; and boiled and skimmed 
cow's-milk and sugar are to be added. At an early age, the thin de- 
coction ; at a later, the milk ought to prevail in the mixture, which 
ought to be given at a temperature of 80° to 90° ; ought to be neu- 
tralized, when acid, with a few grains of bicarbonate or carbonate 
of potassa or soda, and, until infants are eight or ten months old, thin 
enough to be taken through a nursing-bottle." 

Various substitutes have been proposed for cow's-milk ; but they 
are at best constructed on doubtful principles, and vary greatly in 
composition. Liebig's preparation has had the greatest celebrity, be- 
cause of the reputation of its inventor, rather than of its intrinsic 
merit. It is prepared as follows : An ounce of wheaten flour is mixed 
with ten ounces of milk ; it is then boiled for ten minutes, removed 
from the fire, and allowed to cool to 90° Fahr. An ounce of malt- 
powder containing fifteen grains of potassium bicarbonate, and two 
ounces of water, are then stirred into it, and the vessel, covered, 
stands for an hour and a half at a temperature of 100° Fahr. It is 
boiled for a few minutes again, and then strained, when it is ready 
for use. The object of the malt is to transform the starch into glu- 
oose. 

Milk-Jelly. — Prof. Liebreich recommends the following : 

Heat one quart of milk with one pound of sugar, and, when the 
sugar is dissolved, continue the heat at a boiling temperature for about 
ten minutes. 

Now cool it well, and then add, slowly stirring, a solution of one 
ounce of gelatin in a cupful of water. Next add the juice of three or 



MILK DIET. 



55 



four lemons, and three wineglassfuls of wine or brandy. Set in a cold 
place. The milk must be quite cold before the other ingredients are 
added, as it would otherwise curdle. 

At the expiration of six months the milk should be given undiluted. 
An infant's food should always be raised to the temperature of 95° Fahr. 
Regularity in the time of feeding is of very great importance : for the 
first six weeks, every two hours, and subsequently, every three hours. 

Prof. Frankland proposes the following method of converting 
cow's milk into a milk having the same composition as human milk. 
It has much to recommend it, and hence the author invites the atten- 
tion of his readers to the process of preparation : 

"Allow one third of a pint of new milk to stand for twelve hours, 
remove the cream, and add to it two thirds of a pint of new milk as 
fresh from the cow as possible. Into the one third of a pint of the 
blue milk left after the abstraction of the cream, put a piece of rennet 
about an inch square. Set the vessel in warm water till the milk is 
fairly curdled, which requires from five to fifteen minutes, the rennet 
being removed as soon as curdling commences, and put it into an egg- 
cup for future use, as it can be employed daily for a month or two. 
Break up the curd thoroughly and separate the whole of the whey, 
which should be rapidly heated to boiling, when a little more casein 
separates, and may be removed by straining ; one hundred and ten 
grains of powdered milk is to be dissolved in this hot whey, and the 
sweetened fluid added to the two thirds of a pint of new milk." 

By the foregoing process the cow's milk loses a portion of its casein 
and gains in sugar and salts. 

Poisonous Milk and Cream. — The importance of milk as an ex- 
clusive article of diet, as an addition to ordinary aliments, and as a 
constituent of various foods, is so great that some reference must be 
made to the accidents caused by it under certain circumstances. It 
has long been observed that milk and cream during the hot season, 
and sometimes cheese at all seasons, brought on extreme gastric dis- 
turbance accompanied by profound prostration. The cause of this 
change in a fluid so innocuous under other circumstances remained un- 
known until Prof. C. Yaughan, M. D., of the University of Michi- 
gan, made the important discovery. He first isolated & ptomaine in 
poisonous cheese. Subsequently his technical skill was invoked to 
determine the cause of wholesale poisoning from ice-cream, when he 
was able to confirm his former research by the discovery of the toxic 
principle, to which he gave the name tyrotoxicon. This is a crystalli- 
zable principle formed during the course of the butyric fermentation by 
the action of the microbe of this process. It is a powerful irritant 
poison, is acrid in taste, and causes a sense of constriction and a per- 
sistent after-acridity in the fauces ; sets up an intense gastro-intestinal 
disturbance, nausea, vomiting, and purging, followed by profound 



56 RESTORATIVE AGENTS. 

depression of the powers of life. Milk has its disadvantages. Large 
draughts of cold milk at meals form a heavy curd that may try the 
stomach severely. There is reason to believe, also, that milk is hurt- 
ful to the rheumatic and gouty. As lactic acid results from the fer- 
mentation of milk-sugar, or lactose, one of the results of the use of 
milk may be rheumatic fever — for it is pretty generally held that a 
variety of lactic acid is the real cause of this disease. 

ALIMENTATION IN DISEASES. 

Aliment in Acute Inflammations and Fevers. — The febrile 
state induces serious changes in the constitution of solids and liquids. 
The interstitial fat disappears from the tissues, which become soft 
and watery. The muscles grow flabby and pale, and decline in con- 
tractile energy. Digestion is feeble, or suspended or abnormal, and 
the food supplied is either rejected or enters the blood in an imper- 
fectly-prepared state. The blood suffers material alterations ; the red 
corpuscles diminish in number ; the fibrin increases, and the products 
of imperfect tissue-metamorphosis accumulate. The urine is usually 
scanty and high-colored, and loaded with uric acid and urates. The 
chlorides more or less diminish in or disappear from the urine, but 
accumulate in the inflamed tissues. The excretion of phosphates is 
increased. In the tissues, the seat of organic alterations, rapid but 
imperfect metamorphosis ensues, and on the one side pathological ma- 
terials crowd the interstices in the anatomical elements, and on the 
other the products of waste struggle for elimination. Avoiding fur- 
ther speculation as to the fever-process, it will suffice to state that an 
enormous increase of the urea-discharge takes place, and that the 
organs and tissues of the body undergo a granular disintegration, 
which has been designated " parenchymatous degeneration " ; or, as 
it may be stated, the increased temperature of fever represents an 
enormous consumption of the nitrogenous elements. The higher the 
range of temperature, as a rule, the more extensive the parenchyma- 
tous degeneration. 

In fevers and inflammations not of the digestive tract, the most 
useful aliments are milk and beef-juice. These should be given at in- 
tervals determined by their rate of digestibility, usually about every 
three hours. Fresh milk only should be used, and, if the stomach be 
irritable, it may be diluted with one half to one fourth of lime-water. 
It has been conclusively demonstrated that fresh milk is the most 
suitable aliment in typhoid, and it may be depended on wholly (John- 
son). It is equally applicable as the aliment in scarlatina, partly as a 
nutrient, and partly as a diuretic, for in this disease one of the chief 
dangers is from arrest of the urinary secretion. 

The author is convinced that beef-tea and beef-essence are too 
exclusively used in the treatment of the fevers and inflammatory dis- 



ALIMENTATION IN DISEASES. 57 

eases. As an aliment, beef-tea is comparatively inferior, and is also 
difficult of digestion. It is not unusual to see, in cases of typhoid, 
the beef-tea floating on the peculiar dejections of this disease. It 
ought, therefore, never to be used as the exclusive aliment in typhoid 
cases. Another fallacy of a very dangerous kind is current in do- 
mestic practice, viz., the belief that beef-tea, which gelatinizes on 
cooling, is especially rich in nutritive elements. Such beef-tea con- 
sists chiefly of gelatin, which has very little value as a nutrient. 

FORMULAE FOR ANIMAL BROTHS. 

" Beef- Tea. — A pound of lean beef should be freed from fat. tendon, carti- 
lage, bone, and vessels; it must be chopped up fine, and put in a pint of cold 
water to digest for two hours. It should simmer on the range or stove for three 
hours, but the temperature should not exceed 160° Fahr. The water lost by 
evaporation should be made up by the addition of cold water, so that a pint of 
beef-tea should represent one pound of beef. It should be strained, the beef 
being carefully expressed. A wineglassful every three hours is a suitable quan- 
tity for administration in ordinary acute cases. 

''''Mutton-Broth. — Lean loin of mutton, one pound, exclusive of bone; water, 
three pints. Boil very gently till tender, throwing in a little salt and onion ac- 
cording to taste. Pour out the broth into a basin, and, when it is cold, skim 
off all the fat. It can be warmed up as wanted. 

" Chicken-Broth. — Skin, and chop up small, a small chicken, or half a large 
fowl, and boil it, bones and all, with a blade of mace, a sprig of parsley, and a 
crust of bread, in a quart of water, for an hour, skimming it from time to time. 
Strain it through a coarse colander." 

The digestibility of these animal broths is improved by the addi- 
tion of pepsin and muriatic or lactic acids. Beef-essence, obtained by 
pounding finely-divided beef in a mortar until the nutritive elements 
are separated from the fiber, may be administered instead of the 
broths above described. Essence of this kind may be mixed with 
sherry or other wines, whisky, or brandy, provided alcoholic stimu- 
lants be also indicated. The meat solution which Leube employs so 
successfully in the treatment of gastric ulcer and other stomach-dis- 
eases, is prepared by digesting meat, with muriatic acid and pepsin, in 
air-tight vessels, at a high temperature. By this process the meat is 
converted into peptones, ready for absorption. 

FORMULA FOR DIET-DRINKS. 

° Wine-Whey. — Put two pints of new milk in a saucepan, and stir it over a 
clear fire till it is nearly boiling ; then add a gill of sherry, and simmer it for a 
quarter of an hour, skimming off the curd as it rises. Then add a tablespoonful 
more sherry, and skim again for a few minutes. 

u Flaxseed- Tea. — Flaxseed, whole, one ounce; white sugar, one ounce; 
liquorice-root, half an ounce ; lemon-juice, four tablespoonfuls. Pour on these 
materials two pints of boiling water ; let them stand in a hot place four hours, 
and then strain off the liquor. 



53 RESTORATIVE AGENTS. 

" Barley-Water. — Wash two ounces of pearl-barley with cold water. Then 
boil it for live minutes in some fresh water, and throw both waters away. Then 
pour on two quarts of boiling water, and boil it down to a quart. Flavor with 
thinly-cut lemon-rind, and sugar to the taste ; but do not strain unless at the 
patient's request." 

Other foods frequently prescribed for the inflammatory and febrile states are 
wine-whey and " eggnog,' 1 or " egg-flip." To a pint of boiling milk add four 
ounces of sherry; strain and sweeten the whey to the taste. This is a grateful 
subacid drink, but slightly nutritive. Eggnog may be prepared as follows : 
*' Scald some new milk by putting it, contained in a jug, into a saucepan of boil- 
ing water, but it must not be allowed to toil. When quite cold, beat up a fresh 
egg with a fork in a tumbler with some sugar ; beat quite to a froth, add a des- 
sert-spoonful of brandy, and fill up the tumbler with scalded milk." This may 
be used in alternation with beef-tea, or exclusively in acute inflammatory or 
febrile affections, but its administration should not usually be more often than 
every three hours. Milk and egg may be served separately with wine or brandy, 
as follows: "To one tablespoonful of brandy, or one wineglassful of sherry, in 
a bowl or cup, add powdered sugar and a very little nutmeg to taste. Warm a 
breakfast-cup full of new milk and pour it into a spouted jug. Pour the con- 
tents from a height over the sugar, wine, etc. The milk must not boil." 

11 Beat up with a fork an egg till it froths ; add a lump of sugar and two 
tablespoonfuls of water ; mix well, pour in a wineglass of sherry, and serve be- 
fore it gets flat. Half the quantity of brandy may be used instead of sherry." 

The foregoing are the most accessible and the most nutritious ali- 
ments for the acute stage of fevers and inflammations. They contain 
the materials necessary to supply the loss taking place in the organism 
at large, and to repair the damage to tissues in the state of inflam- 
mation. 

Aliments in Diseases of the Digestive Organs. — In acute and 
chronic affections of the digestive organs, especially the latter, the 
skim-milk treatment, already described, possesses the highest value. 
When the trouble is localized to the stomach and is of an acute char- 
acter, only the most easily-digested aliments are borne, as, for ex- 
ample, milk and lime-water, barley-water, tamarind- whey, carbonic- 
acid water, effervescent lemonade, etc. The following formulae are 
useful : 

" To a tablespoonful of pearl-barley, washed in cold water, add two or three 
lumps of sugar, the rind of one lemon, and the juice of half a lemon. On these 
pour a quart of boiling water and let it stand for seven or eight hours. Strain 
it." 

"Boil an ounce of tamarind-pulp with a pint of milk, and strain." 
" Squeeze two large lemons, and add a pint of spring or cistern water to the 
juice and three or four lumps of white sugar. When required for use, pour half 
of it into a tumbler, and add half a small teaspoonful of bicarbonate of soda ; 
stir and drink while effervescing." 

In the chronic affections of the stomach, when digestion is feeble, 
especially of the nitrogenous elements (deficiency of gastric juice), 



ALIMENTATION IN DISEASES. 59 

such aliments as boiled rice, tapioca, arrow-root, unfermented bread 
(aerated bread), and the farinaceous vegetables, are indicated, for 
these foods are digested chiefly in the small intestine. Cases of acid- 
ity and heart-burn, dependent on the fermentation of the starchy and 
fatty elements of the food, require abstinence from the articles con- 
taining them. The acid fruits and vegetables (apples, peaches, toma- 
toes, etc.) are to be preferred under such circumstances to the farina- 
ceous foods. An acid wine (Rhenish or Catawba), taken at the 
principal meal, will often correct the acidity derived from the fermen- 
tation of starch and fat. 

In intestinal indigestion, summer diarrhoea, and cholera infantum, 
it is necessary to supply those foods which undergo solution in the 
stomach, in compliance with the fundamental therapeutical principle 
of giving a suffering organ (the intestine) rest. Starches and fats 
should therefore be withheld. Bread, arrow-root, potato, beans, peas, 
butter, and other fats, increase the disease, because on reaching the 
affected organ they are not finally digested, but act as irritants. This 
result is well seen in the summer diarrhoea of infants. Milk, eggs, 
animal broths, broiled or raw beefsteak, oysters, white-fish, are suita- 
ble aliments under these circumstances. Similar rules obtain in the 
treatment of jaundice from catarrh of the gall-ducts and of biliary 
concretions. The starches and fats are especially active in setting up 
those local disturbances which result in the production of jaundice by 
extension of the catarrhal process from the duodenum along the he- 
patic duct. The use of fat and oil has an immediate result in favor- 
ing the crystallization of the cholesterin, or in causing inspissation 
of the bile. 

Cases of chronic diarrhoea are sometimes remarkably benefited by 
a diet of grape-juice, peaches, and such succulent vegetables as tomato, 
celery, and raw cabbage. It is probable that the cases so benefited 
are really scorbutic in character. The author has known many obsti- 
nate cases of summer diarrhoea of infants to be improved by the ad- 
dition of ripe peaches to the milk-diet. 

A proper regulation of the diet is of great importance in the treat- 
ment of habitual constipation. This usually depends on deficient se- 
cretion, or torpor (a paretic state) of the muscular layer of the intes- 
tines. Corn-bread, cracked wheat, oatmeal, bread of unbolted flour, 
fruits, and such vegetables as green corn, tomatoes, and celery, are in- 
dicated. Those troubled with habitual constipation, to a moderate 
extent, may overcome it by the daily use at dessert of a few almonds 
and raisins, about six of each. Haemorrhoids due to congestion of the 
portal vein, or to constipation, are much benefited by the grape-cure, 
or a diet of fruits and succulent vegetables. 

Aliment in Cachectic States. — To store up fat in the tissues and 
to increase muscular power, the diet must consist of both nitrogenous 



60 RESTORATIVE AGENTS. 

and carbonaceous elements. The fats themselves hold the first place 
as fat-forming foods. Those most frequently employed for this pur- 
pose are the fat of meat, butter, olive-oil, cream, and milk. Sugar 
and saccharine fruits and vegetables rank next in importance as fat- 
formers. The organism has the power of transforming starch into 
fat, whence bread, potato, pastry, rice, arrow-root, etc., belong to this 
class. The malt liquors undoubtedly possess an extraordinary energy 
in the same direction, hence the use of beer and ale by nursing women ; 
but it is undoubtedly true that milk is better for increasing the pro- 
duction of milk. Less force is lost in the conversion of cow's milk 
into human milk than in the complex process needed for transforming 
the nutritive elements of malt liquor. The same fact is true in regard 
to the relative facility of the appropriation of fatty aliment and of 
the conversion of saccharine and farinaceous food into fat. It is also 
true that, for the increase of muscular power, muscular tissues and 
juices are more easily applied by the organism. 

In the scrofulous, mercurial, plumbic, syphilitic, and paludal ca- 
chexia, and in phthisis, a combination of the flesh and fat forming 
foods is necessary. The hunger or denutrition cure, as already ex- 
plained, may be applied to the treatment of these cachexias, the object 
being to produce such waste and molecular changes as to cause the 
elimination of the morbific matters. On the other hand, the object 
sought to be accomplished in these states of disease and in phthisis, 
by improving the body nutrition, is to supplant by fresh material the 
lesions of the anatomical elements. 

In rickets (mollities ossium) it is necessary to supply a food rich in 
phosphate of lime and other phosphate salts. Oatmeal, bread of un- 
bolted flour, cracked wheat, etc., should be added to the dietary. 

Gout, rheumatism, and the so-called uric-acid diathesis, require a 
diet composed chiefly of farinaceous vegetables and acid fruits. Animal 
food and saccharine substances are contraindicated in these disorders. 

In no disease is the influence of diet more conspicuous for good or 
evil than in diabetes. I have already alluded to the milk-cure, revived 
by the Montpellier school and popularized in England by Dr. Donkin. 
All saccharine substances and fruits and vegetables containing them, 
and all farinaceous foods the starch of which is easily convertible into 
dextrine and sugar, are injurious in diabetes. In this prohibition are 
included bread, potato, beets, beans, peas, sugar, milk, pastry, and 
sweetmeats of all kinds. Tomatoes, celery, and raw cabbage, are not 
objectionable. In order to compensate for the loss of bread, the great- 
est deprivation endured by these diabetics, gluten and almond bread 
are now prepared. To supply the deficiency in the alimentation of 
diabetics caused by the withdrawal of the starch elements of the 
food, fats must be used, as butter, olive and cod-liver oil, fat of meat ? 
cream, etc. 



ALIMENTATION IN DISEASES. Gl 

FORMULA FOR VARIOUS ARTICLES OF DIET. 

Lemonade. — " Put the juice of a lemon to a pint of water, in which an ounce 
of sugar has been dissolved ; then add the white of an egg and froth it up. It 
may be iced." 

Farina- Gruel. — " Stir two tablespoonfuls of farina into a quart of water in 
a milk saucepan ; let this boil until it has grown quite thick ; add a pint of milk, 
a little salt, and let it boil fifteen minutes longer ; turn out into a bowl, and 
sweeten to taste." 

Oatmeal- Gruel. — "Put a pint of boiling water into a saucepan; into this 
stir a couple of tablespoonfuls of oatmeal until quite smooth ; let this boil well 
for ten or fifteen minutes, season with salt, then strain through a strainer, and 
add a little port wine and sugar, if the patient may have it." 

Corn-Meal Milk- Gruel. — "Sweeten a quart of milk, and stir in two table- 
spoonfuls of corn-meal. This must be carefully cooked, as the meal is apt to 
scorch, and must be stirred while cooking. A little nutmeg grated on top after 
it is done makes a pleasant flavor. If the gruel is desired thick, more meal will 
be needed." 

Tapioca Jelly. — " One cup of best tapioca put to soak with a pint of cold 
water; when soft put in a saucepau with one cup of sugar, the rind and juice 
of one lemon, a little salt, one pint more water ; stir until it boils ; turn into a 
mold ; set to cool ; add one glass of wine if desired." 

Sago. — " Put half an ounce of sago into an enameled saucepan with three 
quarters of a pint of cold water, and boil gently for an hour and a quarter. 
Skim when it comes to a boil, and stir frequently. Sweeten with a dessert- 
spoonful of sifted loaf-sugar. If wine be ordered, two dessert-spoonfuls; and, 
if brandy, one dessert-spoonful." 

Arrow-root. — "Mix two teaspoonfuls of the best arrow-root with half a 
wineglassful of cold water ; add a pint of boiling water ; put it into an enam- 
eled saucepan, and stir over the fire for three minutes. Sweeten with three tea- 
spoonfuls of sifted loaf-sugar. Add either a wineglassful of white wine, or a 
tablespoonful of brandy, if permitted." 

Arrow-root Milk. — " Mix two teaspoonfuls of arrow-root with a wineglassful 
of new milk ; add half a pint of boiling milk ; put it into an enameled saucepan, 
and stir over the fire for three minutes. Sweeten with a dessert-spoonful of 
sifted loaf-sugar." 

Whipped Cream. — " Beat half a pint of fresh double cream with a whisk, add 
a dessert-spoonful of very finely powdered loaf-sugar, and twenty drops of es- 
sence of vanilla or any other flavoring ; when firm it is ready for use, but much 
improved by being on the ice for an hour or two." 

Corn-Starch Pudding. — " One quart of milk, four tablespoonfuls of corn- 
starch, four eggs, one tablespoonful of butter, six tablespoonfuls of sugar. Dis- 
solve the corn-starch in a little cold milk, and, having heated the rest of the 
milk to boiling, stir this in and boil three minutes, stirring all the time. Take 
from the fire, and while still hot put in the butter. Set away until cold. Beat 
the eggs very light, whites and yolks separately. Stir the sugar and any flavor- 
ing desired in the yolks and then add the beaten whites, and stir in the corn- 
starch, beating thoroughly to a smooth custard. Turn into a buttered dish and 
bake half an hour. To be eaten cold." 

Beef-Juice. — "Broil quickly some pieces of round or sirloin, of a size to fit 
in the cavity of a lemon-squeezer. Both sides of the beef should be quickly 



62 RESTORATIVE AGENTS. 

scorched to prevent the escape of the juices, but the interior should not be fully 
cooked. As soon as ready, the pieces should be pressed in the leinon-squeezer, 
previously heated by being dipped in hot water. The juice, as it flows away, 
should be received into a hot wineglass, and, after being seasoned to the taste 
with salt and a little Cayenne pepper, eaten while hot. If preferred, the juice 
may be frozen." 

Meat-Tea. — "Put one pound each of beef, mutton, and veal, cut into small 
pieces, into three pints of cold water. It should simmer for three or four hours, 
but not boil. When finished, the tea should be carefully strained, and seasoned 
with salt, and Cayenne pepper if preferred." 

Cream-Soup. — " Take one quart of good stock (mutton or veal), cut one 
onion into quarters, slice three potatoes very thin, and put them into the stock 
with a small piece of mace ; boil gently for an hour ; then strain out the onion 
and mace ; the potatoes should, by this time, have dissolved in the stock. Add 
one pint of milk, mixed with a very little corn-flour to make it about as thick as 
cream. A little butter improves it. This soup may be made with, milk instead 
of stock, if a little cream is used." 

Oatmeal-Soup. — " Put two ounces of oatmeal in a basin, pour over it a pint 
of cold water, stir it, and let it stand a minute ; then pour over it, quickly stir- 
ring all the time, a pint of good broth, pour through a fine strainer into a sauce- 
pan, taking care that none of the coarse part of the meal goes into the soup. 
Boil the soup for ten minutes, season and serve." 

ARTIFICIAL DIGESTION. 

We owe to Dr. Roberts, of Manchester, the introduction of partly- 
digested foods, under the term "peptonized." The formulae below 
show the manner in which they are prepared. The liquor pancreati- 
cus mentioned is a solution of the pancreatic juice. This differs from 
the stomach- juice in that it requires an alkali to give it activity. It 
can now be obtained of the pharmaceutists or druggists. 

Peptonized Milk.—" Fresh milk is diluted with water in the proportion of 
three parts of milk to one part of water. A pint of this mixture is heated to 
boiling, and then poured into a covered jug. When it has cooled down to about 
140° Fahr., one or two teaspoonfuls of the liquor pancreaticus, and a small pinch 
of bicarbonate of soda (in solution), are mixed therewith. The jug is then 
placed under a ' cozy ' in a warm situation for one hour. At the end of this 
time the product is again boiled for a couple of minutes. It can then be used 
like ordinary milk." 

• Peptonized Milk- Gruel—" Half a pint of well-boiled gruel is added, while still 
boiling hot, to half a pint of cold milk in a covered jug. The mixture will have 
a temperature of about 125° Fahr. The liquor pancreaticus and the bicarbonate 
of soda are then added in the same proportion as in the preceding process. 
The jug is placed under a ' cozy ' and kept warm for an hour and a half. The 
contents are then boiled for a couple of minutes, and the product is ready for 
use. By this second method the use of the thermometer is dispensed with." 

ISTuTEiENT Enemata.— It not unfrequently happens that the stom- 
ach will not receive and dispose of nutrient materials, when it becomes 



ALIMENTATION IN DISEASES. 63 

necessary to employ nutrient rectal injections. It has been proposed 
to treat ulcer of the stomach by absolute rest of the organ, and the 
introduction of foods by the rectum. In cases of excessive irritabil- 
ity of the stomach the same practice is sometimes necessary. CEso- 
phagotomy and gastrotomy, as also wounds of the stomach, may ren- 
der the use of nutrient enemata indispensable to save life. It should 
not be forgotten that the rectum is not an organ of digestion ; hence 
nutrient enemata must contain the materials for artificial digestion. 
Furthermore, the mucus and fluids of the rectum are alkaline in reac- 
tion. To secure rapid osmosis, therefore, the enemata should have an 
acid reaction. The following formula is suitable for the purpose : 

Beef-tea, prepared as before described, four ounces ; hydrochloric 
acid, ten minims ; glycerole of pepsin (Scheffer's), two drachms. 

If the rectum is irritable, ten to twenty drops of the tincture of 
opium may be added to the injection. If stimulants are indicated, 
brandy may also be added. The rectum soon becomes intolerant of 
injections ; hence, the greatest care should be used in practicing them, 
to avoid sudden distention of the bowel, and frequent introduction of 
nutrient materials should be avoided. Five times in the twenty-four 
hours should be the maximum — for artificial digestion is much slower 
than normal stomach digestion. 

Leube recommends the following as a nutrient injection : " Take 
about five ounces of finely-scraped meat ; chop it still finer, add to it 
one and a half ounce of finely-chopped pancreas free from fat, then 
add about three ounces of lukewarm water, and stir to the consistence 
of a thick pulp." 

Or the following peptonized formula may be used : "A nutritive 
enema should be prepared in the usual way — of milk — or of milk with 
beef -tea or eggs — or of milk-gruel. To half a pint of the warm enema 
a tablespoonful of the liquor pancreaticus and thirty grains of bicar- 
bonate of soda should be added. The enema can then be administered 
at once." 

Supplementary Rectal Alimentation. — Under this designation, Dr. 
A. H. Smith, of New York, describes a method of rectal alimentation 
with defibrinated blood, which seems in a high degree useful. He 
ascertained that " three to four ounces of blood administered at night 
would be so completely absorbed in the course of eight or ten hours 
that no trace of it could be found in the morning evacuation." To re- 
tain the blood fluid, it must be defibrinated at the moment it is drawn, 
which may be done by stirring it with a bundle of twigs as it flows 
away. In chronic cases three to six ounces may be thrown into the 
rectum morning and evening ; in acute cases every two to three hours. 
It may be used cold, but it is better to raise it to the temperature of 
the rectum. Constipation usually results, and in some instances the 
body exhales a rather fetid odor, and the stools are offensive. Another 



04 RESTORATIVE AGENTS. 

objection may be urged against this method : sometimes a foul-smell- 
ing and tenacious material coats the surface of the mucous membrane 
and prevents absorption. For this reason, and to promote a favorable 
disposition of the blood, the bowel should be irrigated with water 
once or twice a week to clear away any retained or adherent mat- 
ters. If the rectum is irritable, a little laudanum may be added to 
each blood-enema. 

Forced Alimentation. — A method of involuntary feeding, proposed 
by Debove, has accomplished so much good that it is necessary to 
give an account of the mode of procedure. It is entitled forced ali- 
mentation, because the nutritive material is introduced into the stom- 
ach through a flexible tube, which has sufficient capacity to conduct 
it, and yet is not too large to pass the oesophagus. The tubes now 
made for the purpose are of non-vulcanized rubber, and have a mark 
at the outer extremity to indicate the distance to the stomach. The 
outer end has, also, a funnel-shaped orifice, for the more ready intro- 
duction of the nutritive and liquid materials. 

The mode of introducing the tube is simple. After being washed 
out with a warm antiseptic solution, it is lubricated with a little vase- 
line. The patient lies down on a bed or lounge, the head extended, 
and the mouth wide open. With the right hand, as if holding a pen, 
the operator passes the tube into the pharynx, taking care to clear the 
epiglottis by keeping close to the posterior wall, the patient making 
successive efforts of deglutition. The stomach is ascertained to be 
entered by the mark on the tube which comes on a line with the teeth. 
Retching usually occurs at first, and more or less pain is experienced 
by the passage of the tube down the oesophagus, but after a few times 
these troubles cease, and neither pain nor discomfort is felt. Some- 
times spasm of the oesophagus occurs, and the onward movement of 
the tube is arrested ; no violence must be used ; the tube should be 
slowly drawn back a little, and then by a gentle movement passed on 
again. If the resistance persists, the attempt should be abandoned 
for the time being, and another made after an interval. When the 
tube is duly in the stomach and the retching or nausea is ended, the 
funnel end is turned up vertically, and the alimentary material is poured 
slowly down. It sometimes happens during the first trials that por- 
tions of the aliment are returned by regurgitation, but this accident 
does not persist after the few trials necessary to habituate the parts to 
the procedure. 

Debove's powder is the nutritive material now most employed ; it 
is desiccated fresh beef, reduced to the finest powder. This powder, 
mixed with water, with bouillon, with milk, etc., is readily poured into 
the stomach, and, in consequence of its extreme tenuity, is easily acted 
on by the gastric juice. The quantity first given is small, but a rapid 
increase can be made. From half an ounce to an ounce of the pow- 



ALIMENTATION IN DISEASES. 05 

dered beef is administered on the first day, but this quantity is soon 
raised to three or four ounces, which is equivalent to four times the 
amount of fresh beef. At the outset a single dose is given each day, 
but, as the tolerance increases, two, three, even four administrations 
are made daily. No other mode of alimentation is attempted, and 
all the alimentary matters are conveyed by the tube into the stomach. 

A remarkable improvement in the condition of the phthisical takes 
place. In a week to ten days the sweats and diarrhoea cease, the 
cough and expectoration diminish, and a considerable gain in weight 
results. A corresponding improvement in the local condition is ob- 
served : the rales lessen and may even disappear, and cavities slowly 
contract. The method can be employed in all forms of phthisis ex- 
cept those accompanied by high fever ; but good results are in pro- 
portion to the limited extent of the lesions. When restoration has 
been effected, the artificial feeding should not be abruptly stopped, 
but gradually, as the natural manner is slowly substituted. 

The method of forced alimentation is not without its inconven- 
iences and dangers. The patient may never acquire the tolerance 
necessary, and hence the method can not be persevered in. By pro- 
ceeding slowly and giving a small quantity at a time, gradually the 
maximum amount may be reached. It is only when anorexia is com- 
plete that forced alimentation need be employed — for those who can- 
eat sufficiently in the natural way do not require such an addition to- 
their alimentary resources. 

As a therapeutical expedient, properly speaking, forced alimenta- 
tion has an important place. Associated with the process of stomach, 
irrigation, it may be useful in a high degree in such stomachal disor- 
ders as catarrh, ulcer, cancer, dilatation, etc. 

In the preparation of Debove's powder, the beef is first cut up finely 
or " minced " by one of the machines now used for that purpose. It is 
then placed in an oven, dried at a temperature of 110° C. or 230° 
Fahr., and when completely desiccated is reduced to the finest powder. 
When completed, the powder has a reddish color, and the taste of 
roasted meat. When mixed with milk it presents the appearance of 
chocolate, is very homogeneous, and passes easily through the tube. 
If the patient is disinclined to submit to the forced process, the pow- 
der can be mixed with malt extract, with bouillon, with soft-boiled 
eggs, and will in this form usually be taken readily, and as an aliment 
is much superior to fresh meat (Dujardin-Beaumetz, Perret, Robin, 
and others). 

It is really doubtful that the forcing method has advantages. 
When food enters the stomach, the gastric juice is poured out more 
or less freely whether or no the salivary secretion is correspondingly 
increased. If the patient can swallow the necessary quantity, it would 
seem to be entirely indifferent how the nutritive powder got into the 
6 



66 RESTORATIVE AGENTS. 

stomach. We learn, also, that appetite, hunger, etc., contribute no 
element to the process, but serve merely as a reminder that the time 
for taking food has come. It follows, also, from the foregoing con- 
siderations, that Debove's powder, or similar aliment, may be admin- 
istered as a medicament, and that the nutrition will be as favorably 
affected by it as various morbid states are by an involuntary medi- 
cation. 

BEVERAGES. 

Coffee. — Tlxe seed of Caffea Arabica ; cafe, Fr. ; Kajfee, Ger. 

Composition. — Coffee contains an alkaloid — caffeine — which is 
nearly, if not quite, identical with theine, a principle found in tea ; a 
volatile oil ; a form of tannic acid ; sugar, gum, etc. The tannic acid 
is that variety known as caffeo-tannic, or caffeic. 

The peculiar odor and flavor of roasted coffee are due to the caffeic 
acid, which is, in part, converted into methylamine ; to the aromatic 
oil ; doubtless, also, to the sugar, which is changed into caramel. 

Preparations. — Coffee is never used in the raw state as a bever- 
age. After roasting, it is made into an infusion or decoction. An 
infusion made at a low temperature, which should not exceed 200° 
Fahr., is better than a decoction. If the heat be too great, those aro- 
matic constituents which impart to coffee its special aroma, are dissi- 
pated. Coffee is now usually prepared by the process of percolation. 
The best product is obtained by steeping the coffee for some time in 
hot water. Coffee can be " settled," or clarified, by the addition of 
some white of egg, or isinglass, or by pouring on from a height some 
cold water. 

Tea. — The dried leaves of Camellia Thea ; the, Fr. ; Thee, Ger. 

Composition. — The constituents of tea are very much the same as 
those of coffee : theine ; an aromatic oil ; sugar and gum, and a pe- 
culiar form of tannic acid. 

Preparations. — Tea is only used in the form of infusion. The 
character and quality of the beverage vary greatly with the kind of 
tea used in the preparation of the infusion. It will suffice to state that 
green tea is more astringent than the other varieties, partly because it 
contains more tannin, and partly because it is sophisticated to adapt it 
to a peculiar taste. 

Cocoa. — Obtained from the seeds of Theobroma Cacao ; cocoa, 
Fr. ; KaJcao, Ger. 

Composition. — The active principle is theobromine, a substance 
which resembles the alkaloids of coffee and tea, except that it contains 
more nitrogen than theine and caffeine. Another important difference 
between cacao and coffee and tea is the large amount of a peculiar fat 
(cacao-butter) contained in cocoa. There is also present a minute quan- 
tity of a volatile oil, on which depends in part the characteristic aroma. 



BEVERAGES. G7 

Actions and Uses. — The use of coffee and tea, or of a correspond- 
ing beverage, is almost universal among civilized nations. This fact 
is supposed to indicate that a need exists in the human constitution 
which these beverages supply. Such a view is hardly tenable, the 
highest physical and mental activity not being incompatible with 
entire abstinence from them. Under some circumstances, however, 
they are peculiarly grateful ; for example, to remove the sense of 
fatigue and hunger, and to allay the mental unrest produced by fa- 
tigue and anxiety. 

Coffee has a somewhat laxative action on most persons ; on the 
other hand, tea has astringent properties — especially that variety 
known as green tea. It has been affirmed and denied that coffee and 
tea lessen the rate of tissue metamorphosis, and consequently the ex- 
cretion of urea. If these beverages check waste, they may be consid- 
ered as indirect nutrients. If used to excess as beverages, they derange 
the organs of digestion and excite functional disturbances of the nerv- 
ous system — on the part of the digestive organs : acidity, flatulence, 
pyrosis, eructations, etc. ; on the part of the nervous system : head- 
ache, vertigo, tinnitus aurium, and confusion of mind. The evil results 
of habitual excess are best seen in sewing-women addicted to tea-tip- 
pling. It is not uncommon for these women to live upon tea and bread 
for long periods, resulting in their becoming excessively nervous and 
dyspeptic. The mucus of the stomach plays the part of a ferment ; 
the bread undergoes the acetic fermentation, and this process is facili- 
tated by the presence of a quantity of a weak astringent solution. 
Disorders of digestion due to this cause can be removed by withdrawal 
of the offending beverage. It is not less true that the after-dinner cup 
of coffee not unfrequently assists the digestion of a too elaborate din- 
ner. Those accustomed to the morning cup of coffee are apt to suffer 
from headache if deprived of their usual beverage, partly because it 
hastens the intestinal movements and assists the morning evacuation, 
and partly because it favors the stomach digestion if not taken in 
excess. 

A cup of strong coffee taken in the early morning is held to be 
prophylactic against malarial infection. Coffee produces wakefulness, 
and opposes opium narcosis ; hence strong black coffee is one of the 
means resorted to in the treatment of opium-poisoning. 

Cocoa, as already set forth, is more directly nutritious than coffee 
or tea, and, as it is rich in fatty matters, is much more difficult of di- 
gestion, so that many dyspeptics can not use it at all. Cocoa is the 
most useful beverage in those conditions of the system requiring nu- 
tritious aliment, especially in phthisis and similar wasting diseases, 
and should constitute a part of the diet in these maladies unless it 
disagrees. 

Caffeine as a remedy will be considered in its appropriate place. 



OS RESTORATIVE AGENTS. 

Milk. — Regarded from all points of view, milk is the most impor- 
tant beverage. Enough has been said on the subject of milk as a food 
for invalids ; but something additional may be necessary on its die- 
tetic position as an ordinary beverage. 

When coifee, tea, and cocoa disagree, milk may be adopted as the 
ordinary beverage, and usually with great advantage. For breakfast 
it may be drunk warm. Large draughts of iced milk, according to 
the American custom, are injurious when drunk at meals ; its tem- 
perature should not be lower than 60° Fahr. If a sense of weight 
and uneasiness follow its use, it will be better borne if diluted one 
fourth to one half with lime-water. If it be desired to improve its 
nutritive qualities, cream to one fourth or to one half may be added. 
In the indigestion of the obese, or in the case of those who suffer from 
hepatic disorders, the milk should be skimmed. A very valuable nu- 
trient, but which is, unfortunately, not very digestible, is chocolate 
made with milk and cream. Such an aliment is especially suited to 
invalids with wasting diseases, but who yet retain the power to digest 
fats. 

Some find it impossible to drink milk, because it induces " bilious- 
ness." In this case skimmed milk should be used. Generally the in- 
digestion called "biliousness " means errors of diet in other directions, 
so that regulation of the food suffices to prevent this form of indis- 
position. 

Authorities referred to in this section : 

Ballot. On the Food of Infants, etc., Medical Times and Gazette, vol. i, IS 70, p. 
331. 

Banting. Letter on Corpulence, pamphlet. 

Bennet, Dr. James Henry. Nutrition in Health and Disease, second edition, Phila- 
delphia, Lindsay & Blakiston, 1876. 

Chambers, Dr. Thomas King. A Manual of Diet in Health and Disease, Philadel- 
phia, Henry C. Lea, 1875. 

Cyr, Dr. Jules. Traite de Alimentation, Paris, 1869, pp. 575. 

Debove, Dr. Bui. Gen. de Therap., 1883, 1884, and 1885. 

Donkin, Dr. Arthur Scott. On a Purely Milk-Diet in the Treatment of Diabetes 
Mellitus, Brighfs Disease, Disease of the Supra-renal Capsules, Fatty Degeneration, etc., 
Lancet, vol. ii, 1869, and vol. i, 1870. 

Dujardin-Beaumetz. Bui. Gen. de Therap., vol. iii, p. 1, et seq. 

Fonssagrives, J. B. Hygiene Alimentaire, deuxieme edition, Paris, 1867, pp. 
670. 

Jacobi, Dr. A. and Dr. Mary Putnam. Infant Diet, New York, G. P. Putnam's 
Sons, 1876. 

Letheby, Dr. H. On Food, second edition, New York, 1872, pp. 255. 

Lebert, Dr. Hermann. Ueber Milch- und Molken-Kuren, Berlin, 1869. 

Mitchell, Dr. S. Weir. On the Use of Shimmed Milk as an Exclusive Diet in Dis- 
ease, Philadelphia Medical Times. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 676. 

Parkes, Dr. E. A. A Manual of Practical Hygiene, second edition, London, 1866, 
pp. 624. 



BEVERAGES. 69 

Pereira, Dr. Jonathan. A Treatise on Food and Diet, London, 1843, pp. 542. 

Richter, Dr. H. E. Bericht uber Milch-, Molken-, und Kumys-Kuren, Schmidt's 
Jahrbucher der gesammten Medicin, vol. cxlviii, p. 201. 

Robin, Dr. These de Paris, Annuaire de Therap., 1884. 

Smith, Dr. A. H. Archives of Medicine, New York, Seguin, I., 1879, vol. i, No. 2, 
p. 113. 

Smith, Dr. Edward. Foods, New York, 18*73 (International Scientific Series), pp. 
485. 

Tardieu. Dictionnaire d? Hygiene Publique, tome xi, Article " Lait" 

Trousseau. Clinique Medicate, vol. ii, p. 695. 

Vaughan, Prop. Victor C. Michigan State Board of Health, 1886, July 13. 

Water. — Aqua, water ; eau, Fr. ; Wasser, Ger. ; Aqua destillata, 
distilled water — water freed from its organic and inorganic impurities 
by distillation. This is alone official. 

Aqua Fluvialis. — River- water. 

Aqua Fontana. — Well or spring water. 

Water as a remedial agent, when employed in internal maladies, 
and as a means of applying heat and cold externally, are the depart- 
ments of the subject coming within the scope of this article. 

Physiological Effects of Water — Internal. — It need hardly 
be stated that water is an essential constituent of the tissues. 

A certain quantity of water or fluid aliment is necessary to the 
digestive process. An excessive quantity impairs digestion, by so far 
diluting the gastric juice as to render it incapable of dissolving the 
foods. Pepsin — the digestive ferment — is also weakened by too great 
fluidity of the stomach contents. The free use of cold drinks — ices 
and iced water — seriously disorders digestion by suspending the action 
of the pepsin, by diminishing the blood-supply needed by the stomach 
in its condition of functional activity, and no doubt also by depressing 
the nerves of the organs of digestion. To this state, induced by the 
free use of very cold drinks during meals, or during the time of di- 
gestion, has been applied the term " ice-water dyspepsia" a very com- 
mon malady in the United States. 

A glass of cold water in the morning before breakfast will in many 
persons cause a satisfactory evacuation of the bowels. The activity 
of the water is increased by the addition to it of a teaspoonful of 
common salt. 

Although water is essential to the constitution of the fluids and 
solids of the body, there is no doubt that large and frequent draughts 
of water may prove injurious by too great increase in the fluidity of 
the blood, and a consequent damage to the red corpuscles. 

The free use of water promotes nutritive changes, and causes in 
some subjects a decided increase in the formation and deposition of 
fat. The presence of water is essential, of course, to the metamor- 
phosis of tissue, whether physiological or pathological. The efficacy 
of mineral waters is in part due to the quantity of water taken, besides 



70 RESTORATIVE AGENTS. 

the mineral constituents. Water may be taken with the view to cause 
increased excretion of certain substances. As a large part of that 
taken passes out by the kidneys, the functional activity of these organs 
is promoted by free drinking. With the water also passes out an in- 
creased amount of urea, chloride of sodium, and phosphoric acid, the 
product of the more rapid tissue-changes which ensue. The increased 
elimination of chloride of sodium does not continue, however. 

Water is also excreted by the skin, and free water-drinking pro- 
motes the cutaneous transpiration, especially when its action is aided 
by external warmth. The vapor of water also passes out abundantly 
in the breath. 

Physiological Effects of Water — External. — The influence of 
temperature must necessarily be considered in connection with the ef- 
fects of water when applied externally. 

Effects of Cold Water. — When an extremity — for example, the 
hand — is immersed in cold water, the temperature of the other hand 
also falls. Cold water abstracts the heat of the body, at least of its 
superficial surface, and affects the condition of the internal organs 
through the nervous system. It is through an influence transmitted 
from the peripheral distribution of the nerves of the hand to the cen- 
ter, and thence reflected to corresponding anatomical nervous connec- 
tions on the other side, that the fall of temperature in the one hand 
is due when the other hand is immersed in water. We have a right to 
assume, therefore, that, when cold water is applied to the whole sur- 
face of the body, changes of temperature take place within. Indeed, 
it has been shown experimentally by Brown-Sequard, that ice applied 
to the lumbar region causes a contraction of the arterioles of the kid- 
neys, and consequent diminished blood-supply to these organs. 

When a cold bath is entered, a marked sense of chilliness is expe- 
rienced, the skin becomes pale and is roughened by the erection of the 
hair-follicles {cutis anserinci), the lips are blue, the breath has a spas- 
modic and catching character, and the pulse is quickened. The tem- 
perature of the surface is lowered, for the blood accumulates in internal 
organs, and the nerves of the skin are depressed. To the change in 
the conditions of the blood-supply, and the impression of the cold on 
the peripheral expansion of the nervous system, are due the coldness 
of the surface, the sobbing respiration, and the feeling of discomfort 
and depression. If the temperature of the water be not too low, and 
if the bodily vigor be sufficient to withstand the shock, the condition 
known as " reaction " speedily ensues. The coldness and depression 
are succeeded by warmth and a feeling of exhilaration ; the pulse 
quickens, and the respiration becomes easy and unembarrassed ; and 
the muscular strength is increased. If, however, the body be immersed 
for too long a period, the condition of reaction is supplanted by cold- 
ness, depression, weakened pulse, and muscular debility. This result 



HYDROTHERAPY. 71 

is largely due to the continuous abstraction of heat, to the accumula- 
tion of blood in the great venous trunks, and the consequent interfer- 
ence with the metamorphosis of tissue. If healthy reaction comes on 
after bathing, the effects are those to which we apply the term tonic. 
The circulation is invigorated, tissue-changes take place more rapidly, 
and the products of increased tissue-metamorphosis are found in the 
urine. With the increased activity of the function of assimilation, 
the appetite and digestive power are improved, and the body gains in 
weight. 

Effects of Waem Water. — The degree of effect which is pro- 
duced by the immersion of the body in warm water is influenced by 
the temperature ; but the quality of the effect is the same at all de- 
grees from tepid to hot. The sense of warmth is at first grateful to 
the feelings ; the skin becomes red from the increased activity of its 
vessels ; the pulse quickens in beats, but diminishes in tension ; the 
respiration is more frequent ; precordial oppression is experienced ; 
an unpleasant sense of distention is felt in the head, and giddiness, 
faintness, and muscular languor, finally, are produced, if immersion be 
prolonged or the temperature be too high. The pulmonary and cutane- 
ous transpiration are increased by the warm bath ; the temperature of 
the body rises, and a condition is established by a hot bath, similar to 
the febrile state. Rapid disintegration of tissue ensues, the waste 
products escape chiefly by the skin and pulmonary mucous membrane, 
and decided loss of weight results. 

Modes of applying Water. — The water of a cold bath should 
have a temperature of 40° to 60° Fahr. If employed for its tonic 
action, the patient should not remain in it longer than the period of 
complete reaction. The tepid bath has a temperature of from 85° to 
95°, the warm bath from 95° to 100° Fahr., and the hot bath from 
100° to 106° Fahr. The duration of the stay in these will depend on 
the purpose to be accomplished, whether mere excitation of the circu- 
lation in the skin, diaphoresis, or muscular relaxation. In directing 
the warm and hot baths, it should not be forgotten that a diseased 
state of the cerebral arteries is a contraindication to their use. 

The vapor of water in the form of the Russian bath, steam-bath, or 
warm or hot wet-packing, may be used to accomplish the same objects 
as those obtained by the warm or hot bath. Without entering unduly 
into the details, it will suflice to state that the Russian bath consists 
in the exposure of the body in suitable apartments to the vapor of hot 
water, at a temperature gradually increased from 95° to 110° Fahr. 
The bath should not, under ordinary circumstances, exceed fifteen 
minutes in duration. In order to overcome the relaxing and debili- 
tating effects of the bath, the patient should either enter a cold bath 
or have cold water dashed over his body. This expedient, conjoined 
with friction of the surface, increases materially the good effects of 



7 '2 RESTORATIVE AGENTS. 

the Russian bath. In the absence of special arrangements for giving 
the Russian bath, simple means will suffice. The patient may sit 
upon a low stool with a blanket pinned about his neck, and under this 
the vapor of water may be conducted. Or, if confined to bed, the 
patient may be placed on a gum-cloth, and the blanket may be ele- 
vated above him by hoops, arranged transversely, under which the 
vapor of water may be conveyed from an ordinary tea-kettle. Fresh 
lime is sometimes used to generate hot vapor. The patient is placed 
on a low stool and surrounded by a blanket. Some pieces oi freshly 
burned lime are then dropped into a vessel of w r ater placed under the 
blanket. The slacking of the lime causes great heat, and the conse- 
quent generation of a considerable quantity of watery vapor, which 
also carries up with it minute particles of lime. This proceeding is 
said to be especially efficacious in membranous croup and diphtheria. 

Enveloping the body in cloths wrung out in hot water, or wrapping 
in a sheet which has been wrung out in hot water, and then covering 
with blankets, is a mode of applying moist heat which may be advan- 
tageously used. To various parts of the body, under the designation 
of " fomentations," warm and hot water applications are constantly 
used in domestic practice. 

The Wet-Pack. — This efficient means of producing the good effects 
of cold-water applications consists in wrapping the body in a linen 
sheet wrung out in cold water. The appliances are these : An ordi- 
nary single bedstead ; a hard mattress covered with several thicknesses 
of blankets or comforters ; a linen sheet. The sheet is dipped in cold 
water, and, when thoroughly wrung out, is laid smoothly on the bed. 
The patient reclines on the sheet, his head supported by a pillow. One 
side of the sheet at a time is then drawn over the patient's body and 
neatly tucked under the opposite side, the feet and legs being lifted 
up and the sheet made to entirely envelop them. Some blankets or 
comforters are now closely applied around the body of the patient. 
There is at first experienced a disagreeable sense of chilliness and dis- 
comfort, which is soon succeeded by a delightful glow. When reac- 
tion is fully established, the wet-pack should be removed, and the 
body be well rubbed with dry towels. The duration of this applica- 
tion should be from fifteen minutes to an hour. When active dia- 
phoresis is the object to be accomplished, the patient must be well 
enveloped in blankets, and continue in the bath for the longest period 
mentioned above. 

JYte Rubbing Wet-Pack. — This is a convenient mode of taking the 
morning bath as a hygienic measure, and also of procuring more 
speedily some of the good effects of the wet-pack as applied above. 
It consists in enveloping the body with a sheet dipped in cold water, 
and rubbing vigorously with the sheet to induce reaction quickly. 
The patient stands up during the application, and an attendant rubs 



HYDROTHERAPY. 73 

those parts inaccessible to the patient. When the sheet is removed 
the skin is dried by the vigorous application of coarse towels, and the 
patieut immediately puts on his clothing. 

When it is not advisable to apply the wet-pack to the whole body, 
or when local diseases require limited application of the wet-pack, the 
sheet may be wrapped around the trunk only, or be confined to the 
region of the affected organ. In cases of extreme debility, or in very 
susceptible persons, the sheet may for the first applications be w f rung 
out in tepid water, and subsequently the temperature of the water be 
lowered to that of the air (40° to 70° Fahr.). 

The Douche. — This consists in the impact against the body of a 
column of water from a height. No greater height than ten feet, and 
a column not larger than four inches, will be proper or safe under any 
circumstances. A hose attached to a water-pipe, the supply being 
regulated by a stopcock, is a convenient mode of using the douche. 
In domestic practice a large pitcher or water-bucket, if provided with 
a suitable spout, may be utilized for this purpose. The douche may 
be either cold, tepid, or hot ; it may have a direction descending, as- 
cending, vertical, horizontal, or oblique ; and the effect may be regu- 
lated by the height from which the w T ater is projected, the size of the 
stream, and the force w r ith w r hich it is thrown against the part. As 
the effect of the douche is very great when the water is cold, when 
the volume of the stream is large, and when it is thrown with force, it 
is obvious that care must be used in directing it against the head, the 
chest, and the abdomen. As a rule, it is too violent a measure to be 
employed in weak and susceptible subjects about the trunk, but it 
may be used freely, of course, on the extremities. 

TJie Hip or Sitz Bath. — As regards temperature, this bath may be 
cold, tepid, warm, or hot, according to the indications requiring it. The 
apparatus for administering it consists of a tin or wooden tub of suffi- 
cient capacity to contain water enough to cover the hips and lower part 
of the abdomen when the patient sits down in it. The tub should have 
a raised back to support the patient, and should be sufficiently elevated 
above the floor, so that the feet may rest comfortably when the patient 
sits down in the water. In the absence of a special arrangement of 
this kind, any ordinary washing-tub will suffice. The duration of the 
hip or sitz bath will be from five to thirty minutes. 

Besides these, various local baths, cold, warm, or hot, under vari- 
ous designations, are used in medical practice, e. g.. foot, hand, elbow, 
and head bath. The effects of these differ in no w T ise from the baths 
already described, except in degree. 

Therapy. — The applications of water in the treatment of disease 
are numerous and important. 

In tonsillitis, diphtheria, and croup, ice held in the mouth and al- 
lowed to come in contact with the fauces is extremely serviceable. The 



74 RESTORATIVE AGENTS. 

wot -pack to the neck gives great relief in the same diseases. The mode 
of applying it is as follows : A napkin is wrung out in iced or cold 
water and wrapped around the neck ; and over this is put a dry towel 
or napkin to prevent evaporation, and also the wetting of the patient's 
clothes. In spasmodic croup {laryngismus stridulus) the application 
of iced water in this way will frequently very quickly stop the crow- 
ing inspiration and allay the distress of breathing. A cold douche 
will effect the same result, but this is an unnecessarily harsh remedy 
in these cases. Sometimes hot applications are more efficacious, when 
the napkin or towel may be wrung out in water as hot as can be borne. 
Cold affusion, or, better, sponging of the body with cold water, is an 
excellent means of preventing laryngisrtius stridulus when it arises 
from cold. 

Habitual constipation may sometimes be overcome by a glass of 
cold water taken before breakfast. Hemorrhoids that bleed, espe- 
cially when attended by constipation, are improved by a daily rectal 
injection of cold water. When cold or warm water injections are used 
to cause an evacuation, it must be remembered that, usually in adults, 
a large amount of water is necessary — about one quart. A small 
quantity of iced water may be effective, for in this case the impression 
of the cold on the nerves of the rectum excites a reflex action of the 
whole intestinal canal. 

Pure water or distilled water is an effective diuretic, especially 
adapted to the relief of acute desquamative nephritis. The action con- 
sists in free discharge of the surplus water by the kidneys, and the 
consequent washing out of the tubules obstructed by the cast-off epi- 
thelium and tube-casts. Large draughts of water, as has already been 
stated, carry out from the kidneys the products of retrograde metamor- 
phosis, and hence the action is diuretic in the widest sense. The effi- 
ciency of many infusions, decoctions, and ptisans, employed in dropsies, 
is largely due to the amount of water ingested. The internal use of 
water in kidney-diseases may be supplemented by hot fomentations to 
the lumbar region. (See article Digitalis.) As irritation of the skin 
of the back has been shown experimentally to influence the caliber of 
the renal arterioles, there is sufficient warrant for the practice of ap- 
plying these fomentations to the lumbar region, when the functional 
activity of the kidneys is insufficient. 

When renal disease is so far advanced that the elimination of urea 
is seriously hindered, and stupor, somnolence, musadar twitchings, and 
even convulsions occur, great relief is obtained by exciting free action 
of the skin by means of the vapor-bath or hot wet-pack, the patient 
being well enveloped in blankets to favor powerful diaphoresis. The 
Turkish bath is very serviceable to restore the suppleness of joints 
and muscles after an attack of acute rheumatism, and chronic mus- 
cular rheumatism is benefited by the same means. No permanent 



HYDROTHERAPY. 75 

good result can be expected from these baths in chronic rheumatic 
arthritis. 

As a means of causing elimination of mineral poisons, baths are 
useful. Lead, mercurial, and paludal cachexia?, are relieved by the 
Turkish bath and the wet-pack, and, although these means are insuffi- 
cient of themselves to effect a cure, they aid very materially the ac- 
tion of other remedies. Increased metamorphosis of tissue and increased 
excretion are, it will be remembered, constant effects of these baths. 
If the wet-packing be used, free diaphoresis should be encouraged, by 
abundant covering and by large draughts of water. 

One of the most important recent improvements in therapeutics is 
the treatment of fevers by cold baths. This is an old expedient, it is 
true, but it is only within a few years that the treatment of fevers by 
baths has been placed within the domain of strictly scientific in- 
vestigation. Various means of applying water in fevers have been 
resorted to — cold affusion, cold baths, cold wet-pack, ice-bags, etc. 
Cold affusion consists simply in dashing successive buckets of water 
over the patient, stripped and lying on a mattress protected by a gum- 
cloth. The applications are continued until the temperature is re- 
duced. This is a crude method, and wears an aspect of harshness 
w^hich may prevent its efficient use in private practice. The cold 
bath is more serviceable, and is free from the objectionable features of 
cold affusion. As practiced according to the method of Ziemssen, 
it is grateful to the patient, produces no shock, and exerts a powerful 
influence over the temperature. The fever-patient is put into a bath 
about the normal temperature of the body (98° Fahr.), and the water 
is cooled, by the addition of ice, to 80° Fahr., to 60° Fahr., or even to 
40° Fahr., according to the effect produced on the temperature, which, 
for this purpose, should be taken in the rectum. When a positive re- 
duction of the fever-heat has occurred, at the expiration of five min- 
utes to half an hour usually, or longer if necessary, the patient should 
be wiped dry, placed in bed, and covered with blankets. The bath 
may be used, according to the nature of the case, from two to six 
times each day, but less frequently if the duration be longer than a 
half -hour. The appliances for administering baths to fever-patients 
are : A strong sheet for lifting the patient from the bed into the bath- 
tub ; a bath-tub provided with an exit-pipe for drawing off the surplus 
water ; a thermometer for ascertaining the temperature of the bath, 
and a clinical thermometer for noting the variations of temperature 
of the patient. Hospitals should be provided with such arrangements 
as have been made at the London Hospital for the use of baths in 
fever. These consist of a small ward with two beds ; a bath-tub sup- 
plied with hot and cold water ; a tank, with which the cold-water pipe 
communicates, in which ice may be put if necessary ; and a large 
waste-pipe for disposing quickly of the surplus water. 



7G RESTORATIVE AGENTS. 

In the absence of suitable bath appliances, the temperature of fever- 
patients may be reduced by simpler methods. Iced water may be 
injected into the rectum frequently ; cloths dipped in iced water may 
be applied to the trunk, and Chapman's ice-bags may be put to the 
spine. More suitable than these methods is the wet-packing. Al- 
though the wet-packing is not so effective as the bath, it is a very 
powerful means of reducing fever-heat, and it has the merit of sim- 
plicity of application, so that in every household it may be used if 
necessary. The patient may be put into the wet-pack several times 
each day, according to the state of the temperature, and may remain 
in it from five minutes to an hour. 

If, after the application of water by any of the modes above men- 
tioned, the circulation becomes feeble, the extremities cold, and the 
lips blue, stimulants should be administered and bottles of hot water 
applied to the feet. The good effects of baths are these : the temper- 
ature declines, the pulse falls and becomes soft and compressible, the 
skin grows moist, and the patient feels refreshed. The repetition of 
the bath or of the application of cold water will be determined by the 
rise of temperature, and of the pulse. Some practitioners employ them 
regularly, as, for example, Yon Ziemssen and Immerman, who admin- 
ister them at 6 a. m., 1 to 3 p. m., and 7 p. m. ; but others — and this the 
author thinks the better plan — give them more or less frequently ac- 
cording to the range of temperature. Not only is the mortality of 
typhoid greatly less under hydrotherapy than under any other method 
of treatment, but the complications which belong to it — except hem- 
orrhage — occur less frequently. 

The most conspicuous triumph of the water-treatment of the py- 
rexial state is seen in the management of hyperpyrexia, a condition of 
things in which a sudden and rapid rise of temperature takes place, 
the range being in extreme cases from 105° to 112° Fahr. It is now 
perfectly well known that any temperature above 108° Fahr. is almost 
necessarily a fatal sign. This condition of hyperpyrexia occurs some- 
times in acute rheumatism, delirium tremens, fevers, etc., and has here- 
tofore not been amenable to treatment. A fatal result in these cases 
may be averted by cold baths, the temperature of the bath being rap- 
idly reduced from 96° to about 60° Fahr., by the addition of ice. It 
is sometimes necessary in these cases to prolong the stay in the bath 
to two or three hours, but it must not be forgotten that no absolute 
rule can be made, the state of the patient's pulse, respiration, and tem- 
perature being the guide not only as to the temperature of the bath, 
but the duration of the stay in it. 

Typho-malarial fever is best treated by the same means ; but ma- 
larial fevers are, of course, so unquestionably remediable by quinine 
that any other treatment is a waste of time. Baths are, however, ex- 
tremely grateful in the pyrexial stage of malarial fevers. 



HYDROTHERAPY. 77 

Cold baths are of equal utility in scarlatina. In mild and uncom- 
plicated cases of this disease, no remedies are required, and simple 
sponging of the body, followed by inunctions of oil, is all that is 
required. When, however, the temperature rises to 104°, 105°, 106° 
Fahr., and higher, and there is delirium or stupor, the rash being dark 
and indistinct, and the urine scanty, the cold wet-pack will often ren- 
der most signal service. The rash will reappear and become vividly 
red ; the pulse, respiration, and temperature, will decline. The cold 
wet-pack to the neck, and frequent gargling of the throat with warm 
water, relieve the sore-throat, and are really more effective than the 
caustic applications so commonly resorted to. When the urine becomes 
scanty and highly albuminous, hot fomentations to the lumbar region, 
with or without addition of medicaments, are often very serviceable. 
The vapor-bath, or the warm wet-packing, by determining free dia- 
phoresis, relieves the brain when convulsions are threatened, or have 
actually occurred, from uraemia. 

Other eruptive diseases, measles, small-pox, cerebrospinal menin- 
gitis, are advantageously treated in the same way. 

Constitutional syphilis is very much ameliorated, and the cure by 
specific treatment hastened, by a course of Turkish baths, or wet-pack- 
ing. Three baths should be taken each week. If the wet-packing be 
used, the patient should remain in it until free diaphoresis is pro- 
duced. 

The wet-packing is very efficacious in acute rheumatism, but the 
prejudices of the patient, and of the patient's friends, often interfere 
to prevent its use. If there be much pain and soreness, the front of 
the body may be packed, and the inflamed joints may be separately 
swathed, but, whenever practicable, the packing should include the 
whole body. A vapor-bath is often very serviceable. A vinegar 
vapor-bath has been used, it is said, with great advantage. This ap- 
plication may be readily made in the following way : Some bricks 
are previously heated ; the bedclothes are elevated above the patient 
by hoops transversely placed ; and vinegar is poured over the heated 
bricks, which have been laid under the bedclothes. The perspiration 
which follows these baths should be wiped off, the skin quickly sponged 
with tepid water, and then dried with a soft towel. Great relief is 
experienced from these applications ; the joints are less tender, the 
fever declines, and the acid perspirations are diminished. Chronic 
rheumatism, if chiefly muscular, and if changes have not occurred in 
the joints, which are simply stiff, and chronic gout, are much benefited 
by the Turkish bath. 

In acute cerebral congestion, the cold douche may be applied to 
the head, while the feet are immersed in warm water. A piece of ice, 
held against the nape of the neck, acts powerfully in the same way. 
The alternate application of ice and hot water is often more effective 



78 RESTORATIVE AGENTS. 

than ice alone. The author has seen these alternate applications of 
ice and hot water have an excellent effect in the stupor of opium nar- 
cosis, of uraemia, and in carbonic-acid poisoning, occurring under vari- 
ous conditions. 

In inflammatory affectio7is of the meninges, and in meningeal hem- 
orrhage, a bag or bladder of pounded ice has the sanction of universal 
use. The author believes that these applications are often made with- 
out due discrimination in cerebral hemorrhage and other allied states. 
When the face is pale, the surface cool, and the circulation depressed, 
cold applications to the head are harmful. Ice to the head, and fric- 
tions of the surface with ice, are very serviceable in sunstroke or ther- 
mic fever, when the surface is hot, the pupils contracted, and the 
pulse full and bounding. The cold wet-packing gives great relief 
under the same circumstances, but, when the symptoms of depression 
exist, these cold applications are hazardous. Usually, however, in 
thermic fever, the range of temperature is very high, and the most 
important indication is to abstract the heat, which can be best accom- 
plished by application of ice or the cold wet-pack, or the cold bath. 
The results of the practice are in accordance with this theory, for 
these applications have been most successful in restoring patients in 
imminent danger of death. When, in delirium tremens, the head is 
hot, the conjunctivae injected, the face flushed, and the pulse strong, 
an ice-bag to the head, or cold affusion, or a mild douche, will assist 
in quieting the patient, and favor the production of sleep ; but these 
measures will do mischief when considerable depression of the bodily 
powers exists, and they are of doubtful utility in any case affording 
evidences of atheroma of the cerebral arteries, or of cardiac disease. 
Cold affusion to the head and spine, and cold baths, are among the 
most important means of relief in chorea. Wakefulness in children 
and adults may be often overcome, and quiet sleep insured, by a tepid 
bath taken just before retiring ; but, when the head is hot, the eyes 
brilliant, and the circulation active, cold should be applied to the head, 
while the body is immersed in the tepid bath. 

The shower-bath, the douche, and cold affusion, were formerly 
much used to calm the violence of acute mania and maniacal delirium. 
The great depression of the powers of life which the douche and the 
shower-bath have caused in some cases, and the fatal results which 
have occurred during their administration, have led to their disuse by 
many alienist physicians. By others, they are held to be extremely 
serviceable in appropriate cases. Bucknill and Tuke advise the oc- 
casional use of the shower-bath in the excitement of intercurrent mania 
and monomania, and a daily shower-bath in melancholia. They ad- 
vise, further, that the shower-bath should, in the first-named group of 
cases, be used no longer than three minutes, and in melancholia from 
fifteen to thirty seconds, the patient being dried while standing in a 



HYDROTHERAPY. 79 

pan of hot water. The same authors prescribe a warm bath of thirty 
minutes, at 95° Fahr., for the excitement and sleeplessness of various 
forms of insanity, and they affirm that its "tranquillizing effect is 
often wonderful." The simultaneous use of cold affusion to the head 
and the warm bath has been warmly advocated by M. Brierre de 
Boismont, and is decidedly approved by Bucknill and Tuke, who ad- 
vise that the duration of the bath should not exceed one hour. The 
wet-pack is an exceedingly valuable remedy in the excitement of acute 
mania, but this measure should not be allowed to degenerate into a 
means of restraint merely. It should be applied in the mode already 
described, and the patient should continue in it until free diaphoresis 
is established. 

In infantile convulsions great benefit is derived from the general 
warm bath combined with cold affusion, or an ice-bag, to the head. 
Hysterical convulsions are quickly relieved in the same way, and the 
hysterical state is much improved by a daily shower-bath. 

Water, cold and warm, in the state of vapor, as ice, has been largely 
applied in the treatment of tetanus and hydrophobia, but without 
good results beyond the merest temporary assuagement of the patient's 
sufferings. 

lesions of the spinal meninges and of the cord, corresponding 
pathologically to those of the brain, are remediable by similar means 
as respects hydrotherapy. The author has seen remarkable improve- 
ment follow a hot douche to the spine in a case of paraplegia of syph- 
ilitic origin. Erb reports remarkable curative results from the use 
of the " rubbing wet-pack " in chronic myelitis. He advises the use 
of merely tepid water, and opposes the application of the extremes of 
temperature, whether hot or cold. The backache so common in women, 
and frequently due to anaemia of the cord, may be much relieved by 
a sponge dipped in hot water and passed over the spine. The hot 
douche to the spine is often more decidedly serviceable in these dis- 
tressing cases. 

Alterations of sensibility, analgesia, anaesthesia, hyperalgesia, hy- 
peresthesia, are often relieved by hydrotherapy — by the wet-pack, by 
ice, by local hot and cold affusion. Neuralgic affections, especially 
sciatica, are benefited greatly by the wet-pack. Paralyzed parts that 
have become cold and that waste, and that are undergoing other nu- 
tritive changes, are improved in condition by douches, by wet-pack- 
ing, and other methods of the water-cure. 

In inflammatory affections within the chest, wet-packing is very 
useful. As a rule, a hot wet-pack gives more relief than a cold one, 
but the feelings of the patient are a proper guide, In acute pleuritis a 
cold wet-pack applied to the side unquestionably diminishes the pain, 
and no doubt relieves the inflammation. In pneumonia hot wet -packs 
are more suitable. When the organs within the chest are inflamed, it 



SO RESTORATIVE AGENTS. 

is good practice to wrap the whole chest tightly in a pack to limit the 
motion of the chest-walls. The method of proceeding is as follows : 
"Wring out in cold or hot water a large towel, fold it and place over the 
affected side or part ; have in readiness a bandage or long towel suffi- 
cient to encircle the chest, and confine the wet-pack by pinning as 
tightly as possible around the chest the bandage or towel. Spongio- 
piline is an excellent material for making these hot or cold applications. 
The same expedients — the application of cold and the tight bandage — 
are of great utility in pulmonary haemorrhage, but a more decided 
effect, by means of ice-bags to the chest and back, may be procured in 
this condition of things. 

Cold and hot applications have unquestionable value in inflamma- 
tory affections of the abdominal organs. The author has seen excellent 
results from the application of an ice-bag over the swelling in cases of 
typhlitis and perityphlitis. Peritonitis is similarly treated with advan- 
tage. When the inflammation is recent, the abdomen maybe covered 
with an ice-bag of sufficient size. It has been shown that not only may 
the local symptoms of inflammation be abated in this way, but the 
general temperature of the body be thus reduced. It is proper, in mak- 
ing these cold applications, to interpose a napkin or towel between them 
and the skin. 

Pounded ice is an excellent application to strangulated hernia to 
favor reduction, and this has often been sufficient when the taxis failed. 
Ilcemorrhoids that are much swollen and painful, or that bleed, are 
much improved by applications of ice. Bubo and sicelled testicle 
are greatly benefited, and the pain attendant on them relieved, by 
ice. 

Cold to the abdomen in the form of ice or cold water, and ice-water 
thrown into the uterus, or ice introduced into the cavity of the womb, 
are measures of great utility in uterine haemorrhage, whether from 
threatened abortion or post partum. 

Hot-water injections, or the hot douche, is one of the most effective 
measures to be used in chronic metritis. A large quantity of water and 
frequent applications are needed to procure the best results. Not less 
than a quart of water as hot as can be borne, and three applications each 
day, are necessary. A Davidson's syringe, a vessel containing hot 
water, and a suitable vessel to receive the water as it flows away, are 
the materials needed for the vaginal douche. The first effect of this is 
to increase the blood-supply, but a marked degree of pallor of the mu- 
cous membrane follows, the opposite effect to that caused by cold 
water. When there is great relaxation of the vaginal passage and 
the uterus is large and spongy, the cold douche is more serviceable. 
Excellent results are sometimes obtained by the alternate use of the 
hot and cold douche. The free use of filtered rain-water has proved 
very efficacious in albuminuria, and to effect the solution of renal 



HYDROTHERAPY. 81 

calculi. It must be drunk in large quantity. The good effects of 
Bethesda and of other weak alkaline waters must be referred to the 
same action ; for these waters can be drunk in larger quantity without 
distressing the stomach, than the hard waters. They must be used 
freely and for many months, to accomplish curative results. 

The applications of water in surgical practice are numerous and im- 
portant. As a dressing for wounds, contusions, and inflamed parts, it 
is in universal use. The author is convinced that the cold-water treat- 
ment of wounds is often overdone, the circulation in the wounded part 
being too much depressed, whence repair is slow, or sloughing is in- 
duced. The hot-water dressing, or the immersion of the affected part 
in hot water (95° to 100° Fahr.), as proposed and practiced by Prof. 
F. H. Hamilton, of New York, is a method which promises most suc- 
cessful results : 

" The phenomena usually observed in cases of recent lacerated or 
incised wounds, when submerged, are a sense of comfort, yet not abso- 
lute relief from pain ; on the second or third day the parts adjacent are 
swollen but not much reddened ; the integument generally assumes a 
white and sodden appearance, and with only slight tenderness. On the 
fifth, sixth, or seventh day the swelling is greater than usually ac- 
companies other plans of treatment, and, with the inexperienced, is 
likely to excite alarm; but it is found not to be attended with increased 
tenderness, and it pits under pressure, showing that it is a condition of 
oedema chiefly. At this time the granulations are generally covered 
with lymph, or some exudate of a whitish color, and which might easily 
be mistaken for a diphtheritic deposit. At the end of fourteen days or 
thereabouts (the period at which, in most cases, we substitute fomen- 
tation for submersion) the limb is still cedematous, the granulations are 
abundant, sometimes presenting a fresh red appearance, and at others 
covered with the white exudate." 

Prof. Hamilton further remarks : " No treatment hitherto adopted, 
under our observation, has been attended with equally favorable re- 
sults. Under this plan the area of acute inflammation is exceedingly 
limited ; erysipelatous inflammation has been uniformly arrested or re- 
strained when it has actually commenced, and it has never originated 
after submersion ; gangrene has in no instance extended beyond the 
parts originally injured, and, when progressing, it has in most cases 
been speedily arrested (in gangrene, hot water, or water at a tempera- 
ture of from 100° to 110° Fahr., is to be preferred). Septicaemia and 
pyaemia have not ensued in any case in which submersion has been 
practiced from the first day of the accident. Purulent infiltrations 
and consecutive abscesses have been infrequent, and always limited to 
the neighborhood of the parts injured, and of small extent. Trau- 
matic fever, usually present after grave accidents, when other plans of 
treatment have been pursued, as early as the third or fourth day, has 



so RESTORATIVE AGENTS. 

seldom been present when this plan has been adopted, and in no case 
has the fever been intense or alarming." 

For the immersion of hand, foot, arm, and leg, Hamilton has con- 
structed bath-tubs of peculiar shape. He advises this method of 
treatment in contused or lacerated wounds of the extremities. Sim- 
ple incised wounds and amputations are unsuited to this plan of 
treatment. 

I subjoin the titles of some of the most recent and important con- 
tributions to our knowledge of the actions and uses of water. It is 
proper to add that I have also consulted the works of the followers 
of Priessnitz, but they are singularly deficient in accurate and scientific 
knowledge : 

Brand, Dr. Ernst. Die Heilung des Typhus, mit einem Anhang : Anweisung fur die 
Krankemvarter bei Behandlung des Typhus mit Bcidern, Berlin, 1868, A. Hirschwald. 

Braun, Dr. Julius. Systematisches Lehrbuch der Balneotherapies dritte umgearbeitete 
Auflage, Berlin, 1873, pp. 714. 

Fox, Dr. Wilson. Observations on the Treatment of Hyperpyrexia, London Lancet, 
vol. ii, 1871, p. 231, et seq. 

Hamilton, Dr. Frank H. The Medical Record, New York, vol. ix, May 15, 1874. 

Jurgensen, Dr. Theodor. Die Korperwarme des gesunden Menschen (Studien), Leipzig, 
1873, p. 28, et seq. 

Liebermeister, Prof. Dr. Carl. Beobachtungen und Versuche iiber die Anwendung 
des kalten Wassers bei fieberhaften Krankheiten, Leipzig, 1868, pp. 480. 

Ibid. ZiemsserCs Cyclopaedia, American edition, vol. i, p. 206, et seq. 

Ibid. Bandbuch der Pathologie und Therapie des Fiebers, Leipzig, 1875, p. 598, et seq. 

Yalentiner, Dr. Th. Handbuch der allgemeinen und speciellen Balneotherapies George 
"Reimer, 1873, pp. 850. 

HEAT. 

Physiological Actions. — It is difficult to assign heat to its proper 
position in a systematic classification. As a stimulant to the vital pro- 
cesses, it pertains to the class of agents promoting constructive meta- 
morphosis ; but, in its influence on the interchanges of repair and waste, 
the action quickly passes into the stage of waste. As its therapeutical 
employment is almost entirely confined to the range of constructive 
metamorphosis, it seems more appropriate to embrace it in this divis- 
ion of the subject. 

The normal heat-production of the body varies singularly little in 
health. Every considerable rise of temperature above, every consider- 
able fall below, the normal of 98*5° Fahr., indicates the existence of 
disease. The various external causes of disturbance of the heat-pro- 
ducing function of the body do not, in health, affect the normal stand- 
ard, because of the existence of a regulating apparatus. Every one 
is familiar with the fact that the human body can be exposed, without 
risk, to a temperature much above its own standard, provided the heat- 
regulating function is in a condition of healthy activity. If, however, 
the transmutation of heat into another mode of motion can not be 



HEAT. 83 

effected, then the complexus of morbid actions, called fever, is at once 
established. Every increment of heat added to the body, unable to 
transmute it into another mode of motion, adds to the existing tem- 
perature. 

Very important alterations take place in a body, the seat of a fe- 
brile process. Increased waste, the result of more rapid oxidation, 
occurs ; the excretion of urea, and, according to some authorities, of 
carbonic acid, is increased ; and those important and wide-spread le- 
sions, entitled parenchymatous degenerations, develop in various organs 
of the body. 

Modes of applying Heat. — 1. Solar Heat.— The rays of the sun 
may be applied directly to the whole surface, or to any part of the 
body. When the whole body is exposed to the rays of the summer 
sun, the head and face ought to be protected. The skin becomes 
warmer, the capillaries dilate, an erythematous blush appears, and the 
amount of blood in the peripheral vessels is increased above the nor- 
mal. The rays of the sun in midsummer, ranging from 95° Fahr. to 
125° Fahr., produce considerable burning heat, and cause a superficial 
inflammation of the skin, which is followed by desquamation. When 
the heat is less powerful, only an agreeable sensation of warmth may 
be experienced. Decidedly caustic effects may be produced by the 
concentration of the solar rays on a small spot of integument by a 
double-convex lens — a burning-glass, it has been called. This may be 
utilized as a means of counter-irritation. 

Besides the heat, the solar rays contain chemical or actinic rays ; 
and hence it is not improbable that chemical effects of a very impor- 
tant kind, or, it may be, catalytic effects, follow the application of the 
solar rays to a considerable portion of the body. Further, it can not 
be doubted that excitation of the cutaneous nerves by the heat and 
chemical rays of the sun must affect the condition of the brain and 
spinal cord, and, through the sympathetic system, the nutrition of 
the body. 

2. Artificial Heat. — There are various modes of applying arti- 
ficial heat. It may be dry or moist. 

Moist Heat. — The Vapor-Bath. — It consists simply in the appli- 
cation of the vapor of water to the surface of the body. Sufficient at- 
tention, for the limits of this work, has been bestowed on this subject 
in the article on "Hydrotherapy." 

Dry Heat. — To the general surface of the body dry heat may be 
applied by simply raising the temperature of the air of the apartment, 
the body being uncovered. Local application of dry heat may be 
made to any part by means of woolen cloth, earthen plates, sad-irons, 
bags of salt, bricks, etc., heated to the proper temperature. The ef- 
fects of these applications depend largely on the amount of heat con- 
tained in these objects. They produce at first the sensation of warmth, 



S4 RESTORATIVE AGEXTS. 

redness of the skin, and may cause vesication, or deep-seated burning 
and destruction of the tissues. 

The Turkish Bath. — This differs from the Russian bath, in that it 
consists of dry air without the presence of the vapor of water. The 
human body can exist in dry air at a very high temperature, without 
injury, for a short period, provided it is in a state of health. The 
temperature of the air of the Turkish bath ranges from 95° Fahr. to 
160° Fahr., but the highest point is attained at the conclusion of the 
process. There are usually three apartments, so that the patient 
passes from one grade of temperature to another, and thus avoids the 
unpleasant, even dangerous, effects of high heat suddenly applied. 
When the temperature reaches 110° Fahr., already some distress is ex- 
perienced. As the heat increases, the breathing becomes short, hur- 
ried, and labored ; the action of the heart is tumultuous ; an unpleas- 
ant sensation of heat and irritation, with itching, is felt over the whole 
body ; the head has a feeling of fullness, with constriction of the fore- 
head and ringing in the ears ; perspiration soon begins, and, when the 
temperature reaches the highest point, is very profuse. 

It is obvious that a decided impression is made on the organism by 
a Turkish bath. The first effect of the heat is on the sensory nerves — 
the impression of warmth. The peripheral vessels dilate, and, of course, 
admit into them a larger amount of blood, with the effect to diminish 
the amount of blood in the internal organs. The temperature of the 
blood rises with the increase of heat ; the action of the heart corre- 
sponds, and a state of fever would be quickly induced if the excess 
of heat were not at once disposed of by the perspiration, in which, ac- 
cording to the doctrine of the correlation of forces, it disappears as 
motion. The circulation being more rapid, and the peripheral vessels 
containing more blood, a more active metamorphosis of tissue proba- 
bly takes place. Elimination is more active through the skin, but is 
less active through the intestinal canal and the kidneys. The acidity 
of the urine is increased, and the water and salts are relatively dimin- 
ished. Remotely, the tension of the vascular system falls, absorption 
becomes more active, the muscular tonus declines, and the sensibility 
of the nervous system and of the special senses is lowered. 

Therapy. — Warm applications possess a high degree of utility in 
the various painful and inflammatory affections of the abdominal or- 
gans. Acute peritonitis, local or general, is probably more frequently 
benefited by applications of ice. As a rule, the feelings of the patient 
furnish the guide to the selection of the temperature. In the ab- 
sence of any specific indication from the feelings of the patient, 
the following rule may be adhered to : If the case be one of pain 
without fever or inflammation, warm or hot applications ; if inflamma- 
tory, cold. Those materials which retain heat and moisture longest 
are to be preferred ; for example, the material known as spongio- 



AIR. 85 

piline, poultices of flaxseed-meal, flannels wrung out in hot water and 
covered with oiled-silk, etc. When the weight of the application is 
objected to, a light material, like a bag of hops dipped in hot water, 
may be applied. In affections of the pelvic viscera, the same modes 
of application can be resorted to, under the same conditions. 

Heat, especially dry heat, is a very important remedy in sudden 
and alarming depression of the vital powers, with feebleness of the 
heart's action and coldness of the surface. Active haemorrhage, of 
course, contraindicates its employment. Feeble infants, born at term 
or prematurely, are often saved by the application of dry heat — the 
highest temperature which can be borne without blistering being ne- 
cessary. The methodus medendi is simple enough : the heating of 
the blood in the superficies of the body increases the movement of 
both heart and lungs. High heat, especially if long continued, is de- 
cidedly contraindicated in cases of fatty and fibroid degeneration of the 
heart, in cases of carditis, considerable obstruction of the orifices, etc. 

Hot-air baths, and hot applications of any kind, may be dangerous 
in old subjects, and in those persons of middle age who present the 
evidences of degenerated vessels. Not unfrequently, attacks of mi- 
graine, cases of ordinary neuralgia of the fifth, tic-doidoureux of mild 
form, etc., are relieved by hot, dry applications made over the course 
and peripheral distribution of the affected nerves. Stupor and coma, 
due to urwmia, or to narcotic medicines, may be relieved by dry heat 
applied to the neck. The alternate use of cold and heat is generally 
more efficient. In neuralgia of the larger nerves, dry heat is pallia- 
tive. In irritable spine, the so-called spinal irritation, dry heat is an 
efficient remedy. In these cases solar heat is especially serviceable — 
the sun's rays falling on the spine, or, what is better, the rays concen- 
trated by a burning-glass on various points on the spine. 

Probably the most generally useful application of dry heat is in 
the treatment of chronic rheumatism and in general dropsy. In the 
treatment of these maladies, elimination is the object to be accom- 
plished: in the one case, of certain excrementitious substances, notably 
of uric acid ; and in the other, of water by the skin. 

The Turkish bath has an unquestionably good effect in constitu- 
tional syphilis. Here there are two objects to be accomplished — to 
promote the action of the mercurial medicines and of the ptisans, and 
to secure elimination through the skin. In the same way the Turkish 
bath is highly useful in plumbic, mercurial, and paludal cachexia, 
Our French colleagues maintain the superior value of sulphur-vapor 
baths in the cachexia} produced by the mineral poisons. 

AIR. 
The Atmosphere. — As a therapeutical agent, only, is air to be con- 
sidered here. Nevertheless, various hygienical relations of the subject 
are also therapeutical, and must therefore be included. 



86 RESTORATIVE AGENTS. 

Composition. — The atmosphere is a mechanical mixture of oxygen, 
nitrogen, and we should also add carbonic acid, and the vapor of water. 
In round numbers there are 21 parts of oxygen, 79 parts of nitrogen 
by volume, and "033 per cent of carbonic acid. The essential constit- 
uents — oxygen and nitrogen — are quite uniform in proportion in all 
parts of the world, but the carbonic acid and vapor of water vary con- 
siderably, owing to local causes. Contrary to the generally received 
opinions, the quantity of carbonic acid is greater at the tops of the 
highest mountains than on the plains, and the oxygen less. The 
amount of moisture is determined chiefly by temperature, and when 
the air can contain no more, it is said to be saturated. A trace of am- 
monia also is present in the air, and a minute quantity of active oxy- 
gen or ozone. 

When a beam of electric light is made to traverse the atmosphere, 
minute particles, previously invisible to the eye, and some even extra- 
microscopic, come into view. The lowest forms of life — microzymes, 
bacteria, etc. — are found in great numbers ; in cities, particles of car- 
bon, lime, and other earthy matters, fibers of cotton and woolen cloth, 
leather, ordure of animals, etc. ; in the country, pollen of plants, and 
particles of vegetable tissues ; in hospital wards, pus-cells and other 
matters derived from the persons, wounds and discharges, bedding, 
and utensils of the sick. We owe our present knowledge of these 
accidental constituents of the air chiefly to the researches of Prof. 
Tyndall. 

Various gaseous matters are also accidentally present in the air, 
varying in different localities in consequence of local telluric condi- 
tions, and certain trades and manufactures. As respects the first, there 
are carbonic acid and carbonic oxide, sulphureted and phosphureted 
compounds of hydrogen, marsh miasm, etc. Under the second may 
be included sewer-gas, gaseous emanations from decomposing animal 
matter, from chemical works of various kinds, etc. 

Physiological Effects. — 1. Pure Air. — When air is breathed' in 
the process of respiration, the oxygen passes into the blood, and car- 
bonic acid, the vapor of water, a trace of ammonia, and some organic 
matter, pass out. The blood which leaves the lungs is changed in 
color, from the dark, purplish hue of venous, to the scarlet of arterial 
blood ; it has gained oxygen, and lost carbonic acid and water. The 
cause of the diffusion of gases in the lungs is chiefly the difference in 
tension of the gases in the blood and in the atmosphere — the tension 
becoming equal in the process of respiration (Hermann). 

In the tissues where oxidation processes are taking place, there is, 
also, a respiration process going on, consisting in the formation and 
excretion of carbonic acid. 

2. Impure Air. — So essential to life is the supply of oxygen to 
warm-blooded animals, that they can not be deprived of it, even for a 



AIR. 87 

very short time, without danger to life. As pure oxygen can not be 
inhaled for any considerable period without injury, admixture with 
some " indifferent gas " becomes necessary. Thus nitrogen is utilized 
in the formation of atmospheric air. The other indifferent gases are 
hydrogen and light carbureted hydrogen, or marsh gas : when mixed 
with oxygen, they can be breathed with impunity ; when inhaled 
alone, they cause dyspnoea and asphyxia. 

Certain other gases are entitled " irrespirable," because, owing to 
the chemical actions instantaneously set up, they can not be inhaled. 
Some of these irrespirable gases are acid — as carbonic, muriatic, hypo- 
nitrous, sulphurous, etc. ; others form acids by combination with oxy- 
gen, as nitric oxide, etc. ; others are alkaline, as ammonia ; others es- 
tablish an ozonizing action, as chlorine, bromine, etc. 

Other gases are comprehended in a group as " poisonous," of 
which there are three classes. The first class contains those which 
seize and combine with the oxygen of the blood, decomposing haemo- 
globin. They are hence called "reducing gases," of which sulphu- 
reted hydrogen, phosphureted hydrogen, etc., are examples. The 
gases of the second class displace the oxygen and enter into combina- 
tion with the haemoglobin. Carbonic oxide and nitric oxide are ex- 
amples of these displacing gases. The third class contains the gases 
used for the production of anaesthesia. 

In the process of respiration, the air loses its oxygen, nitrogen is 
relatively partly increased, carbonic acid accumulates, and certain ill- 
defined " organic matters " appear. This vitiated air exerts a most in- 
jurious influence, and soon becomes unfit to sustain life. The amount 
of carbonic acid which can be breathed without injury has not been 
definitely ascertained, but is greater than is commonly supposed. 
According to Pettenkofer and Yoit, 10 per 1,000 volumes produce no 
discomfort. When, in a crowded apartment, headache, vertigo, and 
feeble circulation are apparently caused by the quantity of carbonic 
acid present, these results are in part due to the lessened supply of 
oxygen, and to the action of nitrogen and organic matters. 

The foul air from cesspools and sewers affects the health of man 
in two modes : by the direct action of the gases of decomposition, 
and indirectly by acting as carriers of the germs of disease. As re- 
spects the former, its injurious influence has probably been exagger- 
ated ; for the original observation of Parent-Duchatelet, that workmen 
engaged in cleaning the sewers of Paris suffered from no diseases due 
to their occupation, has been abundantly confirmed in the subsequent 
experience of the French officials. It is probable, also, that certain 
persons possess a high degree of susceptibility to the action of sewer- 
gas, and are affected by comparatively minute quantities. When 
sewer-gas is admitted to private houses, and is breathed by such sus- 
ceptible persons, they decline in health, become easily fatigued, lose 



88 RESTORATIVE AGENTS. 

appetite and suffer with nausea and diarrhoea, waste, and have an 
earthy, sallow complexion. If the gas is more concentrated, they 
experience more acute symptoms, and have attacks of a choleriform 
character. Of course, asphyxia is produced when the gas is so con- 
centrated as to displace oxygen entirely, as is the case sometimes in 
old drains and privy-vaults, the air of which, as is well known, may 
extinguish life speedily. 

Sewer-gas, examined microscopically, is found to be loaded with 
minute particles, the lowest forms of life, etc., and hence it is in a high 
degree probable that the germs of fevers, dysentery, cholera, diph- 
theria, etc., may in a similar manner be conveyed by it. 

Effects of Compressed Air. — Our knowledge of this subject is de- 
rived in part from observations made on workmen engaged in under- 
ground avocations requiring them to labor under greatly increased 
barometric pressure ; in part from observations made on patients un- 
dergoing the compressed-air treatment ; and in part from experimental 
researches on animals. 

Not to enter too far into details out of place here, it suffices to 
state that the inhalation of compressed air lessens the respiratory 
movements and the number of heart-beats, and increases the arterial 
tension. The effect of this change in the conditions of the circulation 
is to diminish the amount of blood in the veins and auricles, and to 
increase it relatively in the ventricles (Sanderson). On ophthalmo- 
scopic examination of the fundus oculi it has been ascertained (Yon 
Yivenot) that the blood-vessels of the retina diminished in size with 
the increase in the pressure. Compressed air does not appear to in- 
fluence materially the production of carbonic acid, but it does the 
absorption of oxygen (Von Liebig). The changes induced in the 
phenomena of life under high barometric pressure have been carefully 
studied by Paul Bert, who seems to have established that the evil 
effects of such pressure are largely due to the formation of bubbles 
of gas in the blood. He finds that nitrogen is dissolved in the blood 
during the time of high pressure, and returns to the gaseous state 
when the pressure ceases. He further ascertained that the bubbles of 
gas obstructed the circulation at various points, especially in the lum- 
bar portion of the spinal cord, causing paraplegia. When the ac- 
cumulation of gas was sufficient in amount, the pulmonary circulation 
was obstructed and the heart paralyzed by the sudden distention. 
MM. Blanchard et Regnard have studied the changes taking place 
in the spinal cord under the action of nitrogen. Numerous haemor- 
rhagic foci, and evidences of parenchymatous myelitis, were discovered 
in the entire cord. The myelitis presented the usual characteristics : 
hypertrophy and varicosity of the axis cylinder, and granular change 
at various points, but least pronounced in the lumbar portion of the 
cord, and most decided in the dorsal region. 



AIR. 89 

Air as a Therapeutical Agent. — As a general rule, the sick 
require more air-space than the healthy. The mere cubic dimensions 
are much less important than the amount of oxygen available for res- 
piration ; but as the sick are more readily affected by draughts than 
the healthy, it follows that the sick require more cubic space, and less 
frequent renewal of the air. It seems generally conceded that 2,000 
cubic feet of air-space per patient is necessary in hospitals and in the 
sick-room to supply the needed amount of oxygen, although a less 
space may be better if provided with the means of frequent changes 
of air without sudden variations of temperature and strong currents. 
A large cubic space of stagnant air will be inadequate to the require- 
ments of the sick. Even when so large an amount of air as 3,700 cu- 
bic feet per hour for each patient has been supplied to a hospital ward, 
the air in it has had a distinctly " stuffy " and offensive smell. Every- 
body is familiar with the fact that the sick and wounded do better in 
tents and in the open air, than in the best constructed military hos- 
pitals. 

If, as has been affirmed by the highest sanitary authorities, 1,000 
cubic feet of air-space is necessary to a healthy adult, it is clear that 
the sick require not less than we have named, 2,000 ; for the renewal 
of the air in the case of the latter must be less rapid. As the means 
for the renewal of the air in the sick-chamber in private houses consist 
of doors, windows, and fireplaces — or natural ventilation — the supply 
to the patient is variable. To insure the best results under these cir- 
cumstances, the bed should be so placed as to be without stagnant 
corners and recesses, and yet not within the range of currents or 
draughts. When the air is still, movements may be produced by 
burning a lamp in the chimney. In cold weather the fire in the fire- 
place induces a strong upward current in the chimney, the air coming 
from all the crevices. It would be quite beyond the subject-matter 
of this treatise to consider the various mechanical contrivances which 
have been proposed, and are now used, to secure proper ventilation in 
public institutions and hospitals ; but it may be useful to mention 
those devices by which natural ventilation in the sick-chamber may 
be promoted. 

Where there are opposite windows, cross-draughts may be prevent- 
ed by the following expedients : 1, by giving an upward slope to the 
window so that the current of fresh air is deflected toward the ceiling ; 
2, by having some of the window-panes doubled, the outer one having 
a space at the bottom of the pane, and the inner one at the top; 3, by 
fastening a block to the upper sash which prevents closing. If there 
are windows at one side only, the room may be efficiently ventilated 
by vertical tubes carried up the walls from some distance (a few feet) 
and communicating with the external air. 

In the fevers, exanthemata, diphtheria, dysentery, etc., an abun- 



00 RESTORATIVE AGENTS. 

dant supply of air is a measure of the highest utility. The result in a 
doubtful case may be determined by the amount of oxygen received 
by the patient. Furthermore, free admission and exit of air is the 
most efficient means of destroying disease-germs, and their retention 
in a stagnant atmosphere intensifies their virulence. In febrile affec- 
tions, the apprehension of "taking cold " may be allayed by the assur- 
ance that the condition of fever is preventive. Draughts, however, 
should be avoided in measles and in all affections of the breathing 
organs. 

There are two conditions in diseases of the respiratory organs, in 
which an abundant supply of air is essential : inflammatory affections 
in which the breathing «pace is encroached upon so that the oxygena- 
tion of the blood is hindered ; and chronic maladies, as emphysema, 
asthma, etc., in which labored breathing is a consequence in part of 
mechanical defects. Considerable diminution in the supply of air has 
a powerful influence in the production of consumption. The statistics 
on this point collected by the English Sanitary Commission seem con- 
clusive, and, since their recommendation of increased cubic air-space in 
the barracks, the number of cases of phthisis has materially diminished. 
In the treatment of this disease, a suitable supply of air becomes 
even more imperative. The subjects of this disease should occupy 
apartments, whenever practicable, provided with ample windows and 
fireplace, and frequent renewal of the air day and night should be 
secured by some of the contrivances now used for this purpose and al- 
ready referred to. Whenever, by reason of fever or debility, exercise 
in the open air can not be taken, the patient, suitably clad and pro- 
tected in severe weather, may sit in an apartment with all the win- 
dows and doors open, a part of each day. 

Maladies characterized by a deficiency in the oxidation processes 
throughout the body require increased supply of air under all the cir- 
cumstances of life. The most important of these are diabetes, gout, 
rheumatism, obesity, excess in the production of lithates, etc. The 
good effects of open-air exercise in these disorders result chiefly from 
the increased consumption of oxygen. Ancemia, chlorosis, convales- 
cence from acute diseases, and chronic wasting maladies, also require 
increased consumption of air : the oxygen is even more important than 
the iron which is given so profusely in these cases ; indeed, without 
additional oxygen, the assimilation of the iron can hardly be accom- 
plished. 

Therapeutical Applications of Compressed Air are effected 
by two modes : by placing the patient in a chamber in which the air 
has been condensed by an air-pumping engine ; and by having the 
patient breathe, through a mask closely fitting the mouth and nose, air 
compressed in a portable reservoir. The latter method only is ordi- 
narily available. Without entering into minute details, it will suffice 



AIR. 91 

to say that the former method consists of an air-tight chamber eight 
feet high and seven feet wide, in which three patients can sit comfort- 
ably. The air is compressed gradually to one and a half atmospheres 
— a pressure of twenty-two pounds to the square inch — and the pa- 
tient remains in the chamber about an hour and a half. One of the 
first and most complete arrangements of this kind was erected under 
the supervision of Dr. Liebig (not the chemist) at Reichenhall, Bava- 
ria ; and he has since communicated the results of his large experience 
to the Aerztliches Intelligent- Blatt of Munich. The portable apparatus 
now most used is that of Waldenburg (der transportable pneumatische 
Apparat). This consists of an outer cylinder containing some water, 
and an inverted inner cylinder containing air, which fits into the outer 
one. Obviousty the air within may be condensed or rarefied by low- 
ering or raising the inner cylinder, which is easily effected by applying 
weights. A mercurial manometer indicates the degree of condensa- 
tion, and a water-gauge the height of the water. With the air-cham- 
ber a flexible tube, having an oro-nasal mask attached, communicates. 
With this apparatus the patient breathes either condensed or rarefied 
air at the will of the operator. The author has had arranged for his 
own use a pneumatic apparatus which can be employed for inhalation 
of compressed or rarefied air, and for the atomization of liquids. It is 
only available in cities where a sufficient water-pressure can be ob- 
tained. It consists of a brass cylinder strongly made, and containing 
at the top a stop-cock and pipe for the admission of water, and at the 
bottom a stop-cock for drawing off the water. At the top, also, there 
is a stop-cock and pipe for the attachment of the flexible tube and 
oro-nasal mask, and a gauge for registering the pressure. The admis- 
sion of water effects the compression of the air ; its removal — all the 
stop-cocks being closed — effects the rarefaction. Precisely the same 
results can be attained as in the more complicated arrangement of 
Waldenburg. Furthermore the author's apparatus can be employed as 
an atomizer, using compressed air or steam. 

The applications of compressed air are numerous and important. 
The results are chemical and mechanical. The chemical effects are 
due to the increased supply of oxygen ; the mechanical, to the distri- 
bution of the blood-pressure. In ancemia, chlorosis, amenorrhea, in 
the ' neuralgice, especially of the fifth nerve, headache, epistaxis, in 
gout, diabetes, obesity, etc., very excellent results are obtained by the 
use of compressed air — which means the increased consumption of 
oxygen. To achieve all that is possible to effect in these cases, the 
treatment must be continued for a considerable time. 

It is, however, in certain cardiac and pulmonary affections that the 
pneumatic treatment is especially commended. Acute catarrh, nasal, 
faucial, bronchial, if early applied ; chronic bronchitis, with or with- 
out emphysema, capillary bronchitis, atelectasis, asthma, dilatation of 



92 RESTORATIVE AGENTS. 

the right cavities, and fullness of the venous with ischoemia of the ar- 
terial system, are conditions in which the compressed air is signally 
beneficial. Probably in emphysema, more than in any other malady, 
has the relief afforded by this treatment been most conspicuous ; for 
this is a disease which has hitherto offered few results to therapeutical 
skill. " Die Exspiration in verdiinnter Luft ist das specifische mecha- 
nische Antidot des Emphysems," is the dogmatic statement of Walden- 
burg — " Expiration into rarefied air is the specific mechanical antidote 
to the emphysematous affections." 

The rules for the inspiration and expiration of rarefied and con- 
densed air respectively may be formulated as follows : 

As inspiration of condensed air increases the intra-thoracic air- 
pressure, it impedes the flow of blood to the right auricle, and lessens 
somewhat the pulse-rate, and is accordingly indicated in cases of dysp- 
noea having a mechanical origin, in incipient phthisis, in asthma, bron- 
chitis, and in insufficiency of the mitral. 

As inspiration of rarefied air has the opposite effects to those of 
condensed air, its use is indicated in the few cases in which increased 
inspiratory power is desirable, as in contracted thorax, the result of 
effusion. 

Expiration into condensed air increases the expiratory power when 
deficient, and expiration into rarefied air is indicated in emphysema 
and chronic bronchitis. 

Hot Air. — Since it has been shown by Pasteur that the vinous fer- 
mentation is arrested by raising to the temperature of 160° Fahr. the 
bottles containing new wine, this fact has been extensively applied, 
and is called Pasteurism. Recently the breathing of hot air has been 
brought forward as a remedy for phthisis, and the results of the prac- 
tice have been good. The air, washed, is heated by a Bunsen's burner, 
and then breathed by the patient for a time which is determined by 
the condition. A heat of 200° Fahr. is the initial temperature, and 
this is raised up to 300°, even 400°, and the time occupied from a half 
to two hours, several times each day. 

MASSAGE. 

Definition. — The term massage is probably derived from the 
Arab word mass, which signifies " to knead." The French word mas- 
sage is equivalent to the term shampooing, and is applied to a process 
of rubbing, friction, and percussion of the body. Masseur is a male 
rubber, and masseuse a female rubber — that is, persons who make a 
business of massage. 

Method. — Massage by friction consists in rubbing, rolling under 
the fingers, and gently pinching the skin, and rubbing, tapping, knead- 
ing, and exercising the muscles and joints. Beginning at an extrem- 
ity, the foot for example, the skin is taken up between the thumb and 



MASSAGE. 93 

fingers and rolled and pressed ; then the muscular masses are well 
grasped, rolled and pressed and kneaded, and rapidly tapped a quick 
succession of light blows ; and then each articulation is in turn put 
through all of its motions. Even the muscles of the neck and the in- 
terossei may be subjected to the same treatment, with a little address 
and painstaking. In fact, no part of the body should be omitted ex- 
cept the face. 

Massage by percussion alone consists in applying to various parts 
of the body a very rapid succession of short blows, not forcible enough 
to cause pain. The blows or taps may be made with a wooden spatula, 
with the fingers as arranged for percussion, or with the lateral margin 
of the hand fully extended. 

Dr. Mortimer Granville has accomplished notable results in the 
treatment of neuralgia by rapid percussion over the trajectory of the 
nerves affected. He has devised a small instrument for this purpose, 
called percuteur. The curative results of this delicate percussion are 
attributed by Granville to a modification in the nerve-molecules. 

Physiological Effects. — The good effects of massage are popu- 
larly ascribed to electrical or supernatural agency. That electrical 
currents are induced by massage is true, but the curative effects are 
attributable to other agencies. 

The effects of massage are : 1, local ; 2, systemic. 

1. The masseur or rubber puts forth more or less muscular power, 
which at the points of contact or friction develops or is transformed 
into another mode of motion — heat. The action thus induced in the 
constituent tissues of the parts operated on, also serves to elevate the 
temperature. The vessels dilate and an increased quantity of blood 
enters them, and the motion of the blood-current is accelerated. The 
immediate effect of these changes is to promote the nutritive energy 
of the tissues subjected to friction. This result is seen in the im- 
proved color, warmth, and volume of the parts. 

2. A general rise of temperature, equal in most instances to one 
degree, has been observed to take place quite uniformly (Mitchell). 
The body increases in weight ; all the organic functions are performed 
with more energy, and power is gained in every way. Massage in its 
several forms exercises peculiar effects on the nervous system, which 
should not be overlooked. When an inflamed part which can be ma- 
nipulated, a joint for example, is rubbed with excessive gentleness, 
the sensibility, which was at first so acute that every touch gave pain, 
rapidly subsides, until, after an hour of friction, it may be handled 
with some roughness, without evoking painful sensations. When the 
local condition is that of pain merely, it is remarkable how the acutest 
suffering is alleviated by persistent friction of a gentle kind. Again, 
the state of spasm of a muscle is relieved and relaxation induced by 
persevering rubbing of the affected muscle. Results such as these are 



94 RESTORATIVE AGENTS. 

explicable only on the theory that the gentle titillation of the cutane- 
ous branches of the nerves (end-organs) has so far lowered their irri- 
tability that they cease to receive and transmit painful impressions. 
The rapid and long-continued transference to the centers of conscious 
impressions of the gentle titillation of the end-organs allays the irri- 
tability of the center, so that, if pain be transmitted, it excites no re. 
action, and therefore is not realized. 

Therapy. — Obstinate loakefulness and nocturnal restlessness may 
often be relieved by massage of pressure or percussion. Very gentle 
and long-continued friction of the extremities, especially of the lower 
extremities, is necessary, or corresponding tapping. Simple headache, 
even severe paroxysms of neuralgia, and the spasms of tic douloureux, 
are often most surprisingly relieved by, at first, exceedingly delicate 
frictions of the end-organs of the fifth — the skin of the face, forehead, 
neck, and the scalp — and subsequently stronger rubbing of the same 
parts. The same method has been effective in hemicrania, migraine, 
and spinal pain ( Wester lund, Graham, Putnam, and others). Next to 
electricity, massage is the most useful remedy we possess in the treat- 
ment of infantile paralysis and other wasting palsies, after the acute 
symptoms have subsided. In hemiplegia and other forms of paralysis 
due to intra-cranial lesions, the indications for the treatment by mas- 
sage are a lowered state of the nutrition of the paralyzed parts, cold- 
ness and blueness of the skin, wasting and contracted muscles, ulcer- 
ations, etc. In progressive muscidar atrophy, much more may be 
accomplished by persistent frictions and kneadings of the wasting 
muscles. The treatment should be begun early, and the first indica- 
tions — pain, fibrillary trembling, weakness, etc. — require the massage, 
without waiting for obvious wasting. Of course, any treatment is 
useless when the wasting has proceeded so far that no muscular ele- 
ments remain. 

Probably massage has accomplished more conspicuously good re- 
sults in chronic joint affections, synovitis, contractions and deformities, 
and thickening from inflammatory deposits (Berghmann and Helle- 
day, Billroth, Mosengeil, and others). It is in this class of cases that 
healers, natural bone-setters, and other empirics sometimes achieve 
surprising success in the face of failures by regular surgeons. The 
author therefore especially urges on young surgeons and physicians 
the extraordinary utility of massage in this group of cases, and the 
great results which can be achieved by it, when sections of muscles, 
tendons, and cicatrices may appear to be imperatively demanded. In 
many cases patient and long-continued use of the method may be re- 
quired. 

In the hands of Weir Mitchell, massage has proved of surprising 
benefit in cases of the so-called spinal irritation, with its protean 
manifestations in the nervous, muscular, digestive, and sexual systems. 



MASSAGE. 95 

He uses it as a means of promoting the nutrition of the body generally, 
and of the muscular system particularly, while he maintains the body 
in a condition of nearly absolute rest. 

As the results obtained have been surprisingly great, it were better 
to indicate with some particularity the kind of cases to which massage 
seems best adapted, and we can do no better than employ the graphic 
language of Mitchell : " It includes that large group of women, espe- 
cially, said to have nervous exhaustion, or who are described as having 
spinal irritation, if that be the prominent symptom. To it I must add 
cases in which, besides wasting and anaemia, emotional manifestations 
predominate, and which are then called hysterical, whether or not they 
exhibit ovarian or uterine disorders. Nothing is more common in 
practice than to see a young woman who falls below the health- 
standard, loses color and plumpness, is tired all the time, by-and-by 
has a tender spine, and soon or late enacts the whole varied drama of 
hysteria. . . . But no matter how it comes about, the woman grows 
pale and thin, eats little, or, if she eats, does not profit by it. Every- 
thing wearies her — to sew, to write, to read, to walk — and by-and-by 
the sofa or the bed is her only comfort." 

" In the treatment of these, massage plays an important part. Rest, 
electrical excitation and exercise of the muscular system, systematic 
feeding, are employed in conjunction with massage." 

How far the results in the treatment by massage are affected by 
psychical impression has not been ascertained. The separation of 
these patients from home influences and associations, the confinement 
to bed, and the novel treatment, combine to affect the imagination 
profoundly, and to arouse hope and expectation to the highest point. 
In the class of cases described by Mitchell, these mental influences 
are powerful factors both in causing and curing morbid mental states. 
In illustration may be quoted Davy's celebrated case of paralysis cured 
by the mere application of the thermometer, and the remarkable re- 
coveries which occurred under the religious ministrations and prayers 
of Prince Hohenlohe. 

The extraordinary effects produced by the application of certain 
metals in hysterical subjects (Burq's Metallotherapy) may also be 
quoted in illustration. The results obtained by Charcot from metallo- 
therapy have been even more remarkable than the cures effected by 
Mitchell with massage. 

The Muscle-Beater. — Massage has its ill effects, and is now, like 
the "rest-cure," much overdone. Besides the expense and inconven- 
iences of the treatment, it is used injudiciously in cases of debility, and 
in convalescence, when the material produced is not in excess of the 
needs. 

The muscle-beater may well be substituted for massage in many 
cases. It is composed of a wooden handle of size convenient to be 



96 RESTORATIVE AGENTS. 

grasped, sixteen to eighteen inches in length, and at the end are placed 
two elastic balls of vulcanized caoutchouc, having a diameter of two and 
a half to three inches. Each ball has a small hole in it to permit the 
entrance and exit of air. With this instrument blows of varying force 
and frequency can be made over the body as a whole, or to any part. 

DIGESTION-FERMENTS. 

Pepsin. — Pepsina vel pepsinum / pepsina porci y pepsine, Fr. ; Ver- 
dauioigsstofl) Ger. 

Definition. — A ferment obtained from the mucous membrane of 
the stomach of the pig. There are two processes worthy of mention 
for obtaining the ferment : Scheffer's, and Prof. Lionel S. Beale's. By 
Scheffer's process the mucous membrane is digested in a solution of 
muriatic acid, and the pepsin precipitated with chloride of sodium. 
Beale directs that the mucous membrane be first cleansed and then 
scraped strongly with an ivory knife, so as to remove the contents of 
the gastric glands. The pepsin is contained in the very viscid mucus 
which is thus removed. When spread on clean glass in a very thin 
layer, it is dried at a temperature not to exceed 100° Fahr., and in the 
vapor of hot water or over sulphuric acid. 

Preparations. — Pepsinum Saccharatum. — Pepsin and sugar of 
milk. " One part of saccharated pepsin dissolved in 500 parts of 
water acidulated with 7*5 parts of hydrochloric acid should digest at 
least 50 parts of hard-boiled egg-albumen in five or six hours, at a 
temperature of 100° to 104° Fahr." Dose, 3 j— 3 ij. 

Liquor Pepsini. — Solution of pepsin is composed of saccharated 
pepsin in solution in water and glycerin, and acidulated with hydro- 
chloric acid. Dose : a teaspoonf ul ter in die, usually after meals. The 
wine of pepsin is an unscientific preparation, and should not be pre- 
scribed. Boudault's (really Corvisart's) compound nutritive powder, 
consisting of pepsin, starch, and lactic acid, is an exceedingly uncertain 
preparation, and is often totally inert. Only those preparations of 
pepsin should be used, made by the processes above described, espe- 
cially those of E. Scheffer, of Louisville, Ky. The saccharated pepsin 
and the glycerole are practically unchangeable. 

Ingluvin is a proprietary preparation, said to be made of the 
gizzard of the domestic chicken by drying and pulverization. Dose, 
gr. v — 3j. Ingluvin has the remarkable property of arresting cer- 
tain kinds of vomiting — notably the vomiting of pregnancy. It is a 
stomachic tonic, and relieves indigestion, flatulence, and dyspepsia. 

Recent investigations have shown that ingluvin owes its curative 
effects, not to any ferment corresponding to pepsin, but to a peculiar bit- 
ter principle. This result is the more satisfactory, since such an organ 
as the gizzard could hardly furnish the necessary quantity of a digestive 
ferment to effect the results now known to be produced by ingluvin. 



DIGESTION-FERMENTS. 97 

Under ordinary circumstances, and when the object of its adminis- 
tration is to promote the digestive function, it should be taken after 
meals. When the object is to arrest the vomiting of pregnancy, it 
should be given before meals. 

But only the successful use of this agent and the apparent sincer- 
ity of the composition as given to the public would seem to justify its 
mention here ; but no doubt need be felt as to the propriety of using a 
patented preparation if there is no substitute of equal value. 

Pancreatin. Pancreatic Emulsion. Liquor Pancreaticus. — 
Pancreatin is the ferment of the pancreas. Under the name pancre- 
atic emulsion it has long been used as a means of promoting intes- 
tinal digestion, especially the digestion of the fats. The most effective 
preparation is liquor pancreaticus, obtained by digesting minutely 
divided fresh pancreas with a weak alcoholic solution. As too much 
alcohol injures the ferment, and too little will fail to prevent decom- 
position, it is a nice point to determine the amount most suitable. Five 
per cent of alcohol is probably a near approximation to the proper 
amount. Pancreatin differs from pepsin in that its action is promoted 
by an alkaline condition, and destroyed by strong acidity. In the 
presence of an alkali it has the power to convert proteids into peptones, 
to emulsionize fats, etc. As acids destroy pancreatin, it follows that 
the liquor pancreaticus should not be given while stomach digestion is 
going on, but when the chyme has entered the intestine, in about three 
hours after the taking of food (Roberts). 

In cases of very weak digestion, Roberts suggests the employment 
of " peptonized " foods — i. e., foods that have been acted on by pan- 
creatin and the proteids converted into peptones. The following 
formulae proposed by Roberts will be found useful in some conditions 
of disease : 

"Peptonized Milk. — A pint of milk is diluted with one fourth 
water, and heated to 140° Fahr. Two or three teaspoonfuls of liquor 
pancreaticus, and ten to twenty grains of bicarbonate of soda, are 
then mixed therewith. The mixture is then poured into a covered 
jug, and the jug is placed in a warm situation under a f cozy ' in order 
to keep up the heat. At the end of an hour or hour and a half, the 
product is boiled for two or three minutes. It can then be used like 
ordinary milk." 

"Peptonized Gruel. — Gruel may be prepared from any of the nu- 
merous farinaceous articles which are in common use — wheaten flour, 
corn-meal, oatmeal, arrow-root, sago, pearl-barley, pea-flour. The 
gruel should be very well boiled, and made thick and strong. It is 
then poured into a covered jug and allowed to cool to a temperature 
of about 140° Fahr. Liquor pancreaticus is then added in the propor- 
tion of a tablespoonful to the pint of gruel, and the jug be kept warm 
under a * cozy ' as before. At the end of a couple of hours the prod- 
8 



98 RESTORATIVE AGENTS. 

net is boiled and finally strained." In this process the starch is con- 
verted into sugar, and the albuminoid matters are peptonized, whence 
the gruel assumes a thin, watery consistence. Peptonized gruel is 
administered with peptonized milk. 

" Peptonized milk-gruel is prepared as follows: Gruel is made 
in the usual way, thick and strong ; to this while boiling is added an 
equal measure of milk. To each pint of the mixture add two or three 
teaspoonfuls of liquor pancreaticus and twenty grains of bicarbonate 
of sodium. It is kept warm for a couple of hours, then boiled for a 
few minutes and strained." 

Papaiva or Papain. — MM. Wurtz and Bouchut have given this 
name to a ferment obtained from the Carica papaya. On incising the 
green plant, a milky juice exudes. This juice is white, slightly as- 
tringent, but not acrid, and contains the ferment papain^ which, being 
soluble in alcohol, may by this means be separated. Papain has very 
active digestive power, effecting the solution of albuminous substances 
in a short time. It is found to be an active solvent of false mem- 
brane ; of the intestinal worms, ascarides and taenias. That it is a true 
ferment, with power to convert albuminoids into peptones, is denied 
by Catillon. The evidence offered by Rossbach, Weeg, and others, 
shows that it has considerable digestive power, but as Dowdeswell as- 
serts, not so great as is generally supposed. The action is not probably 
just the same as that of pepsin. Rossbach, in the course of an inves- 
tigation on the effects of papain when injected into the blood, estab- 
lished, as he supposed, that this agent had the power to cause the mul- 
tiplication to an extraordinary extent of microbes already existing in 
the blood. Dowdeswell, repeating these experiments, was unable to con- 
firm Rossbach's conclusions, but ascertained that the organisms were 
formed in the papain solution previous to its introduction into the circu- 
lation, and hence that those found in the blood originated in this way. 

Antagonists and Incompatibles. — Alkalies and the mineral salts 
which precipitate pepsin from its solutions (mercury, lead, zinc, copper 
salts), tannic and gallic acids, creosote, etc., are incompatible. Alcohol 
and the various alcoholic liquors, in sufficient strength, destroy the activ- 
ity of pepsin ; hence the wine of pepsin must be an uncertain preparation. 

Synergists. — Lactic and chlorhydric (muriatic), acetic, citric, and 
malic acids, promote the digestive activity of pepsin. 

Physiological Effects.— Ten grains of the saccharated pepsin, 
prepared by the process of Scheffer, will dissolve 120 grains of coagu- 
lated albumen in four to six hours, at a temperature of 100° Fahr. 
Pepsin is an essential constituent of the gastric juice, and possesses the 
property, especially in the presence of lactic and chlorhydric acids, of 
digesting the nitrogenous constituents of the food (casein, albumen, 
fibrin, etc.), and converting them into peptones. 

Therapy. — Pepsin is, of course, indicated in stomach- disorders 



PEPSIN. 99 

characterized by a deficiency of this essential principle. As Fen wick 
has shown, the amount of pepsin secreted by the gastric glands un- 
dergoes great diminution in various morbid states, as in cancer, dia- 
betes, typhoid fever, and heart-disease. In convalescence from fever, 
therefore, pepsin is indicated, and in the incurable morbid states, men- 
tioned above, it serves a useful purpose in maintaining the function of 
digestion. Fox " bears strong testimony in favor of pepsin " (p. 74) 
in cases of atonic dyspepsia and " irritative states of the mucous mem- 
brane." He prefers to administer it with chlorhyclric acid. In the 
atonic dyspepsia of phthisis pepsin is highly beneficial, especially 
wdien given in connection with pancreatic emulsion. In other forms 
of dyspepsia, accompanied by imperfect solution of the fats and the 
formation of fat-acids, the addition of pancreatic solution greatly in- 
creases the activity of pepsin (Long). 

In the apepsia of infants (Barthez), especially occurring in those 
artificially fed, great benefit is derived from the use of pepsin. Dr. 
Cummins has seen many apparently hopeless cases recover under its 
use, and he regards it as so valuable that he never recommends a wet- 
nurse, but relies on artificial food, the digestion of which is aided by 
the administration of pepsin. Corvisart used his nutritive powder (the 
so-called Boudault's pepsin) with happy effects in the same cases ; and 
Barthez, who applied the term apepsia to this inability of infants to 
digest their proper aliment, has been equally successful in the same 
mode of treatment. The saccharated pepsin should be administered in 
these cases in doses of ten to thirty grains immediately after the child 
has taken its milk or other food, or thirty minims of the glycerole of 
pepsin at the same time. It is better, according to M. Barthez, to give 
pepsin without acid to infants (Trousseau et Pidoux). 

Pepsin is one of the remedies which has been used with success in the 
vomiting of pregnancy. The heaviness and torpor which are felt during 
the progress of digestion in some subjects, and also the gastralgia w T hich 
is produced in this way, may be relieved by its timely administration. 

According to Hollman, the use of pepsin is attended with beneficial 
results in anamiia, chlorosis, atrophy, and allied states, due, no doubt, 
to the better preparation of the peptones for absorption into the blood. 

In chronic ulcer of the stomach and in cancer of this organ, pepsin, 
by facilitating digestion, will diminish the distress of the patient, and 
will contribute to the cure of ulcer and prolong life in cases of cancer. 

Very great success has been attained in the treatment of diarrhoea 
in infants by pepsin. The form of diarrhoea amenable to this remedy 
is due really to an atonic state of the intestinal mucous membrane. 
Every motion contains half-digested food. Soon after taking milk 
or other food, the child becomes uneasy and a discharge takes place. 
Frequently undigested food is vomited as well. If this condition of 
things continues for any considerable time, the child emaciates, and 



100 RESTORATIVE AGENTS. 

the skin wrinkles and becomes dry and harsh. The motions will be 
quickly changed in character, and the nutrition of the child improved, 
by giving pepsin immediately after each supply of food. Facts in 
illustration of this statement have been published by Corvisart, Bar- 
thez, Rilliet, Trousseau et Pidoux, Ellis, of Dublin, Davidson, of 
Liverpool, Hawley, of Brooklyn, and others. 

In cases of entire inability of the stomach to digest food, or when 
surgical operations or accidental injuries prevent the introduction of 
aliments into this viscus, pepsin is added to the nutritive enemata in 
order to insure the preparation of peptones for absorption. Mr. Mal- 
colm Morris reports the cure of an obstinate case of eczema by the 
administration of papain. It was due to indigestion, it is probable. 

The solvent action of papayotin of false membrane is an important 
aid to existing resources. We learn from Prof. Jacobi, of New York, 
whose experience and admirable powers of observation are well known, 
that he has used this agent with considerable success in the treatment 
of diphtheria to dissolve off the membrane. He employs the following 
formula : Papayotin, 1 part ; glycerin and water, of each 4 parts — ap- 
plying it hourly to the membrane. He narrates four cases in which the 
solvent action was most obvious ; one of them having had tracheotomy 
performed, the solution was applied by a feather through the tube. 

Papain has been used with success in the treatment of the round- 
worm and of taenia. There seem to be two modes in which it can be 
made to act on intestinal parasites ; as a digestive in connection with 
alkali, and as a taeniafuge. In the former case, as much as the patient 
can take for several days is given three to five hours after meals, with 
sodic carbonate in sufficient quantity to carry it well into the intestine 
without interference by the stomach acid. The intention of this mode 
of administration is to secure digestion of the parasite in the same way 
that other albuminous substances are disposed of. When it is pur- 
posed to form peptones in the small intestines, the prepared aliment is 
carefully given, so that the stomach juices can not act on it, as above 
stated. The other mode consists in its toxic action on the parasite, so 
that it lets go, and, being stupefied, is readily swept out with the other 
contents of the bowel. The amount necessary to accomplish this is 
two to four or more drachms, and the time and mode of administration 
are the same as when other taeniafuges are given. That the action of 
the papain is that of an intoxicant, and that it thus secures the dis- 
charge of the tape-worm is not more singular than the effect of pump- 
kin-seed emulsion, which also seems to stupefy the parasite. 

When employed as a taeniafuge, several drachms are given in the 
early morning fasting or before meals, the preparation of the patient 
having been made as it is when other remedies for tape-worm are 
made use of. 



LACTIC ACID. 101 

ACIDS. 

Acidum Lacticum. — Lactic acid / acide lactique, Fr. ; Milchsaure, 
Ger. 

Properties. — It is an acid, sirupy liquid, which contains 75 per 
cent of absolute lactic acid, and has a pale wine-color. Specific 
gravity, 1'212. It mixes in all proportions with water, alcohol, and 
ether. 

Incompatibles and Antagonists. — Alkalies and the mineral 
salts. 

Synergists. — Pepsin, sodium chloride, vegetable acids, chlorhydric 
.acid, etc. 

Dose. — Fifteen minims to 3 ss in water before or after meals, ac- 
cording to the conditions present. 

Physiological Action. — As lactic acid is a frequent constituent of 
the gastric juice, it has undoubtedly an important function in connec- 
tion with digestion. Used medicinally, it promotes the appetite and 
facilitates digestion. In large doses ( 3 j) it gives rise to epigastric 
pain, flatulence, and loss of appetite. As lactic acid is one of a series 
of homologous acids, containing butylactic, valerolactic, and leucic 
acids, it is not improbable that some of these may result from its oxi- 
dation when administered in excess. It probably combines with bases 
and forms lactates, for it displaces not only the volatile but some of 
the mineral acids from their combinations. Chemical investigations 
have indeed confirmed this, for, besides free lactic acid, lactates have 
been found in the gastric juice. It is not known definitely whether 
free lactic acid occurs in the blood in the healthy state, but it certainly 
does in some morbid conditions. According to Lehmann, lactates are 
rapidly converted into carbonates in the blood. Free lactic acid, as 
was long ago shown by Berzelius, is found in muscular fluid, and has 
also been detected in the. spleen by Scherer. Although it is not always 
a constituent of normal urine, yet, when the supply of lactates to the 
blood is considerably beyond the oxidizing power of the blood, it has 
been found (Lehmann). Scherer has shown also that lactic acid is 
present in the exudates of puerperal fever. 

Lactic acid has the power to dissolve a considerable quantity of 
freshly-precipitated phosphate of lime. 

The suggestion made by Prout, of a relation between an excess of 
lactic acid in the blood and rheumatic inflammation, received a re- 
markable confirmation in the experiments of Richardson, who produced 
endocardial inflammation by injecting lactic acid into the peritoneal 
cavity of dogs. Further confirmation of this connection has been af- 
forded in the attacks of acute rheumatism which have occurred in sub- 
jects of diabetes treated by lactic acid. 

Therapy. — Solutions of lactic acid are of great utility as solvents 
of false membrane. Since the comparative demonstration of solvents 



102 RESTORATIVE AGENTS. 

made by Brieheteau and Adrian, it has been employed successfully by 
Dr. Weber, of Darmstadt, and Dr. Dureau, in croup, applied by means 
of a- pulvtrisateur in the strength of thirty to forty drops to the ounce 
(Waldenburg), and is also advocated by Morell Mackenzie and Lennox 
Browne. The following is the formula used by Mackenzie at the London 
Throat Hospital : 3 Acidi lactici, 3 iijss ; aquse destil., § x. M. This 
may be used in a spray -producer, or be applied on a mop to the affected 
part. It is unquestionably an excellent solvent of the exudation of diph- 
theria, as the author has frequently observed. It may be used also as a 
gargle when the exudation does not extend beyond the tonsils and the 
pillars of the fauces. For this purpose sufficient acid may be added 
to water to give a distinctly sour taste. As the application is free 
from danger, it may be used as often as every half -hour. When used 
in the form of spray, care must be had to prevent the acid hurting 
the eyes. 

Chiefly in atonic dyspepsia is lactic acid employed. In this con- 
dition it is, so to speak, a physiological remedy, being a constituent 
of the gastric juice ; therefore it is supplied artificially, because the 
stomach is unequal to the task of producing it. Generally, it is ad- 
visable to combine pepsin with it thus : 3 ~LA<{- pepsinse, 3 xij ; acidi 
lactici, 3 iv. M. A teaspoonful three times a day after meals is a 
proper dose for an adult. In the apepsia of infants, characterized by 
the presence of undigested aliment in the discharges, this combination 
is an excellent remedy. If a marked degree of acidity exists, the acid 
should be omitted, or given before the milk, when it may prevent the ex- 
cessive production of acid. In irritative dyspepsia, when the pain and 
suffering are due to slow and imperfect digestion, lactic acid will often 
give great relief, either alone or combined with pepsin. Cases of acid- 
ity and heartburn are often quickly relieved by lactic acid given before 
meals. When the presence of an excess of the phosphates, uric acid, 
and the urates, and of oxalate of lime, in the urine, is due to imperfect 
digestion and faulty assimilation, as is frequently the case, lactic acid 
is serviceable. Dr. Deecke advocates the use of lactic acid in chronic 
cystitis, as a means of arresting the ammoniacal decomposition of the 
urine, a condition in which he holds it to be very effective. 

Lactic acid has been used with varying success in the treatment of 
diabetes. The object to be gained is the prevention of sugar formation 
from the starchy and other elements of the food. Dr. Foster reports 
some cases apparently decidedly benefited, and Dr. Ogle gives an ac- 
count of two cases in which no good results were attained. Cases have 
been lately reported in which the patients were improved by the use of 
lactic acid, but, on the whole, the utility of this agent in diabetes must 
be held to be as yet subjudice, besides the danger of setting up an 
endocarditis, or other changes in the intima of the vessels, that might 
be even more serious than the malady for which prescribed. 



MINERAL ACIDS. 103 

Authorities referred to above : 

Bricheteatt, Dr. Felix. Bulletin General de Th'erapeutique, vol. lxxiv, p. 72. 

Butler, Dr. N. L. Treatment of Croup by Lactic-Acid Spray. The Practitioner, 
vol. vii. p. 189. 

Dureau, Dr. Bulletin General de Therapeutique, vol. lxxxiii, p. 45. 

Jaffe, Dr. Die Diphtherie. Schmidt's Jahrbucher der gesammten Medicin, vol. cxlix, 
p. 321. 

Ogle, Dr. John TV., and Dr. Balthazer Foster. British Medical Journal. 

Lehmann, Prof. Dr. C. G. Physiological Chemistry, American edition, vol. i, p. 
85, et seq. 

Mackenzie, Dr. Morell. The Pharmacopoeia of the Hospital for Diseases of the 
TJiroat, London, 1872. 

Nothnagel, H. Handbuch der Arzneimittellehre, Berlin, 18*70, p. 376. 

Ranke, Prof. Dr. J. Grundzuge der Physiologie des Menschen, zweite Auflage, Leip- 
zig, 1872, p. 248. 

Waldenburg, Dr. L. Die locale Behandlung der Krankhelten der Athmungsorgane, 
Berlin, 1872, p. 403. 

Mineral Acids. — Acidum Sulphuricum. — Sulphuric acid. " A 
liquid composed of not less than 96 per cent of absolute sulphuric 
acid. A colorless, oily liquid, inodorous, and having strong acid and 
corrosive qualities. The specific gravity of sulphuric acid should be 
not less than 1*840. It is miscible in all proportions with water and 
alcohol, with the evolution of heat." 

The official preparations into which sulphuric acid enters are aci- 
dum sulphuricum aromaticum and acidum sulphuricum dilutum. 

Acidum Sulphuricum Dilutum. — Diluted sulphuric acid. " Sul- 
phuric acid, 1 part ; water, 9 parts. This contains 10 per cent of the 
official sulphuric acid, and has the specific gravity of 1*067 nearly." 
Dose, TUv — in, xxx, and should be well diluted with water when ad- 
ministered. 

Acidum Sulphuricum Aromaticum. — Aromatic sulphuric acid, or 
elixir of vitriol. " Sulphuric acid, 200 parts ; tincture of ginger, 
45 parts ; oil of cinnamon, 1 part ; and sufficient alcohol to make 
1,000 parts. The specific gravity should be 0*955. , Dose, ni v — 3 j> 
well diluted with water. 

Acidum Hydrochloricum. — Hydrochloric, formerly (U. S. Phar., 
1870) muriatic acid. "A liquid composed of 31*9 per cent of abso- 
lute hydrochloric acid and 61*1 per cent of water. It should have a 
specific gravity of 1*160. It is a fuming, colorless liquid, of a pungent, 
suffocating odor, and an intensely acid taste and reaction." The 
official preparations into which hydrochloric acid enters are acidum 
hydrochloricum dilutum, acidum nitrohydrochloricum, and acidum 
nitrohydrochloricum dilutum. 

Acidum Hydrochloricum Dilutum. — Diluted hydrochloric acid. 
" Hydrochloric acid, 6 parts ; distilled water, 13 parts. This mixture 
contains 10 per cent of absolute hydrochloric acid, and has a specific 
gravity of 1*049." 



10-1 RESTORATIVE AGENTS. 

Acidurn NUricum. — Nitric acid. "A colorless, fuming, very 
caustic and corrosive liquid, of a peculiar, somewhat suffocating odor, 
and a strongly acid reaction. Specific gravity, 1*420." The official 
preparations of nitric acid are acidum nitricum dilutum, acidum nitro- 
hydrochloricum, and acidum nitrohydrochloricuin dilutum. 

Acidum NUricum Dilutum. — Diluted nitric acid. "Nitric acid, 
1 part ; distilled water, 6 parts. This solution should contain 10 per 
cent of absolute nitric acid, and have a specific gravity of 1*059. 
Dose, in, ij — tti x, in sufficient water. 

Acidum Nitrohydrochloricum. — Nitrohydrochloric acid, also known 
as aqua regia. Nitric acid, 4 parts ; hydrochloric acid, 15 parts. Dose, 
■nx ij — tii x j we U diluted. 

Acidum Nitrohydrochloricum Dilutum. — Diluted nitrohydro- 
chloric acid. Nitric acid, 4 parts ; hydrochloric acid, 15 parts ; dis- 
tilled water, T6 parts. A colorless, faintly yellow liquid, odorless, or 
having a faint odor of chlorine, and a very acid taste and reaction. 
Dose, iu v — tti, xx, in sufficient water. 

Acidum Phosphoricum. — Phosphoric acid. "A colorless liquid, 
odorless and of a strongly acid taste and reaction. Specific gravity, 
1*347." Dose, iu j — ^ x > well diluted. 

Acidum Phosphoricum Dilutum. — Phosphoric acid, 20 parts ; dis- 
tilled water, 80 parts. Dose, tti v — ^ xx ? m sufficient water. 

Antagonists and Incohpatibles. — Alkalies and their carbon- 
ates, salts of lime and lead. 

Synergists. — Bitters and tonics in general. 

Physiological Actions. — By assisting digestion and by correcting 
an abnormal condition of the alimentary mucous membrane* acids 
directly contribute to the blood-forming process, and indirectly, through 
the blood, to the construction of tissue, and the bettering, in general, 
of the bodily condition. 

The mineral acids grouped above agree in the general qualities 
of their actions, but differ in some particulars. They attack the 
living tissues with great energy, abstract the water, and combine 
with the potash, soda, and lime bases. In virtue of this affinity for 
water and this power of combination with bases, they cause destruc- 
tion of tissue and are called eschar otics. Some of them are more 
powerful than others : thus, sulphuric and phosphoric acids pen- 
etrate more deeply than the others. Nitric acid stains the skin yel- 
low ; sulphuric acid carbonizes or blackens. Hence in cases of acci- 
dent, or when these acids are used with criminal intent, it is very ob- 
vious at a glance which has been taken or given : nitric acid making a 
yellow stain of the face, lips, and mouth, and sulphuric carbonizing 
or blackening those parts. In the stomach they produce the same ef- 
fects. When concentrated, they destroy the mucous membrane of the 
mouth, epiglottis, oesophagus, and stomach. The systemic effects are 



MINERAL ACIDS. 105 

those of the irritant and corrosive poisons. The appropriate rem- 
edies are chemical and mechanical : alkalies, magnesia, soda, lime, 
soap, to neutralize the acid ; and eggs, milk, oil, etc., to protect me- 
chanically the tissues. The depression of the powers of life which 
immediately follows the ingestion of a mineral acid should be treated 
by opium, nutrient and stimulating enemata, and the intra-venous in- 
jection of ammonia. 

The mineral acids, when administered in medicinal doses, must on 
reaching the stomach act in accordance with their chemical position. 
They will combine with the bases and form salts. Hydrochloric, and 
to a less degree phosphoric, aid digestion, acting as synergists to pep- 
sin, and contribute to the formation of peptones. Sulphuric unites with 
bases to form insoluble sulphates, and precipitates the albuminous sub- 
stances from their solution in the gastric juices ; hence this acid, 
although for a brief period it improves, soon disorders digestion. It 
is true of all the mineral acids that their long-continued use diminishes 
the production of acid gastric juice, and in this way after a time they 
cause the very troubles for the relief of which they were originally 
administered. An acid solution on one side of an animal membrane, 
and an alkaline solution on the other, is the condition most favorable 
to osmosis. Hence the introduction of an acid into the stomach with 
sufficient frequency and in sufficient quantity must impair the produc- 
tion of acid gastric juice. In practice this is found to be the case. 
The mineral acids are among the most diffusible substances known, 
and of these hydrochloric stands at the head. So much of these acids 
as does not enter into combination in the stomach diffuses quickly into 
the blood, and the salts which they form by combination with bases 
follow the laws of diffusion according to their class. The acids, es- 
pecially the hydrochloric, and next nitric, diminish the alkalinity of 
the blood, and in this way accomplish all that they are capable of 
doing as systemic remedies. 

Therapy. — Not much need be said of the use of the mineral acids 
in affections of the mouth and throat. Formerly they were much em- 
ployed in the treatment of mercurial and other forms of stomatitis, 
diphtheria, aphtha?,, gangrene, etc. 

In using mineral acids in affections of the mouth, it should not be 
forgotten that they attack the enamel of the teeth. First, the animal 
matter adherent to the teeth is dissolved off, when the teeth are said to 
be " set on edge." The acid should be applied to the affected surface 
only, and the mouth should afterward be washed out with an alkaline 
lotion. Pure hydrochloric acid may be applied with a camel's-hair brush 
or on a bit of soft pine-wood to the gums in cases of sloughing from 
mercurial stomatitis, and to the ulcers of stomatitis materna, to syphi- 
litic mucous patches, and to those painful ulcers of the mouth which 
occur periodically in some subjects affected with a peculiar form of in- 



106 RESTORATIVE AGENTS. 

digestion. In the ease of ulcers having their origin in stomach-dis- 
order, the internal nse of hydrochloric, nitric, or nitro-hydrochloric 
acid, is often extremely beneficial. 

The local nse of hydrochloric acid in diphtheria, so strongly urged 
by Bretonnean, is now rarely employed, for it is well known that the 
diphtheritic exudation will rapidly extend over an inflamed surf ace pro- 
duced by the application of the acid, and the destruction of the exu- 
dation at one part does not prevent its extension and renewed forma- 
tion. 

Any of the mineral acids administered by the stomach should be 
well diluted, and to prevent injury to the teeth should be taken through 
a glass tube or a straw. The mouth should also be rinsed out after 
swallowing the acid. 

The mineral acids are highly useful in certain stomach-diseases. In 
atonic dyspepsia hydrochloric acid should be given after meals, or better, 
lactic acid. It is highly probable that hydrochloric acid is produced 
during digestion by the reaction between chloride of sodium and lactic 
acid. A combination of the acid with pepsin, as already suggested, is 
preferable in these cases of atonic dyspepsia. When, in consequence 
of faulty digestion, acetic, lactic, and butyric acids are produced in the 
stomach from the starchy, saccharine, and fatty constituents of the food, 
the acids given after meals add to the distress of the patient. 

To prevent the excessive formation of acid, whether due to the ac- 
tion of the gastric glands, or to abnormal fermentation of the starchy, 
saccharine, and fatty elements of the food, mineral acids are used with 
decided advantage, but they must be administered before meals. For 
this purpose, hydrochloric or phosphoric acid is to be preferred. The 
excessive production of acid is manifested by acid eructations, pyrosis, 
heartburn, and idcerative stomatitis. 

Indigestion characterized by eructations of offensive gas, a sal- 
low complexion, by the appearance of oxalate-of-lime crystals in the 
urine, accompanied by mental despondency, is relieved by nitro- 
muriatic acid ; better by nitric, when the symptoms of lithsemia are 
predominant. 

The experience of English physicians practicing in India has been 
favorable to the use of nitro-muriatic acid in chronic hepatic affections, 
and in dysentery and dropsy of hepatic origin. Acute diseases of the 
liver, and such chronic affections as cirrhosis and icaxy degeneration, 
are not as a rule benefited by the mineral acids. Mucous duodenitis 
and catarrh of the gall-ducts accompanied by jaundice, and jaundice 
of malarial origin, are forms of hepatic disease in which nitro-muri- 
atic acid is serviceable. With the internal use of the acid should be 
conjoined the local use to the right hypochondrium of the acid-bath. 
Three ounces of nitro-muriatic acid to a gallon of water is a suitable 
strength for the topical use in this way. The feet may be placed in the 



MINERAL ACIDS. 107 

bath, and the legs, arms, and abdomen may be alternately sponged, 
when the skin is torpid and its secretion defective. The temperature 
of the bath should be about 96° Fahr. (Martin). Another mode of 
making topical application of the acid bath is as follows : " Let a flan- 
nel roller of ten or twelve inches wide, and sufficient to encircle the 
body twice, be soaked in the fluid and then wrung so as to remain only 
clamp. Apply this instantly to the body, covering it with a piece of 
oiled-silk to avoid damping the dress. It should be worn constantly, 
but should be changed, soaked, and wrung, morning and evening " 
(Squire). This is a very effective local application in the hepatic dis- 
orders mentioned above as amenable to treatment by the mineral acids, 
and is serviceable in the first stage of cirrhosis. Dr. Scott, of Bom- 
bay, ascribes to the acid bath the power to relieve the pain of hepatic 
colic, by causing the expulsion of the impacted calculus. 

The mineral acids are very effective remedies in the treatment of 
summer and colliquative diarrhoea. Crapulous diarrhoea and dysen- 
tery are not benefited by them. The indications for their use are these: 
painless, watery evacuations, of a light color, alkaline in reaction. 
Hope's mixture, which contains nitrous acid, has long been used with 
success in such cases. The formula is as follows: t^ Acidi nitrosi, 3 j ; 
tincturaB opii, gtt. xl ; aquas camphorse, f viij. S. : One fourth to be 
taken every three or four hours. A mixture of this kind may readily be 
extemporized, in which the relative proportion of the acid and opium 
may be arranged according to the indications of the case. Sulphuric 
acid is more decidedly astringent than nitric and muriatic, and is, 
therefore, as a rule, to be preferred in diarrhoea. Bence Jones places 
them as regards their actions thus: Hydrochloric more promotes diges- 
tion; nitric acid, secretion; and sulphuric, astringency. Nitric and nitro- 
hydrochloric are, according to this view, better suited to stomach and 
hepatic disorders characterized by deficient secretion, and sulphuric is 
more appropriate for the relief of a relaxed state of the mucous mem- 
brane. A combination of aromatic sulphuric acid with opium is one of 
the most effective remedies we possess in the treatment of summer diar- 
rhoea and cholera. Sulphuric acid may also be used with advantage in 
the treatment of dysentery, in combination with sulphate of magnesia. 
fy Magnesii sulphat., 3 j; acidi sulphur, dil., 3 ij; morphine sulph., gr. j; 
aquae, f iv. M. S. : A tablespoonf ul every three or four hours. After the 
action of a saline laxative, Hope's mixture, or an extemporized prescrip- 
tion of a similar kind, may be used. When the mineral acids do not 
quickly improve the discharges and lessen their frequency, and when 
they increase the tormina and tenesmus, they should be suspended. In 
the treatment of cholera, dilute or aromatic sulphuric acid may be given 
frequently, well diluted, in full doses. Opium can be added at such 
intervals as may be indicated. MacCormac has found the acid to be a 
most valuable prophylactic against cholera attacks. It should be ad- 



10S RESTORATIVE AGENTS. 

ministered with promptness when the preliminary diarrhoea is threat- 
ened. 

Mineral acids, especially the muriatic, are very serviceable in fevers. 
Tbey were formerly classed as refrigerants, or cooling medicines, and 
were supposed to allay thirst and to diminish fever. Although these 
notions are no longer entertained, the acids are known to render an im- 
portant service in fevers. They increase secretion of the mucous mem- 
brane, and thus relieve the dryness of the tongue and fauces. As in 
fevers the gastric juice is deficient in acids, digestion is materially aided 
by their administration. In typhoid fever, the acids restrain somewhat 
the exhausting diarrhoea, increase the digestive power, remove or 
diminish the dryness of the tongue, and, it may be, destroy the mi- 
crobes, which constitute the poison of typhoid, or which produce it 
under circumstances favorable to their development. Hydrochloric 
acid is preferable in the treatment of fevers. It may often be advan- 
tageously administered in beef-juice. 

In scarlet fever, hydrochloric acid is frequently combined with 
chlorate of potassa (producing euchlorine), but it is better adminis- 
tered alone in this disease. Besides the internal administration of 
the acid, it is often mixed with water and used as a gargle, or mixed 
with honey and applied with a brush to the throat. One part of acid 
to five parts of honey or ten of water is a strong enough solution for 
this purpose. In the other eruptive fevers, hydrochloric acid is serv- 
iceable to allay thirst, to increase digestion, and to obviate the tend- 
ency to adynamia in these diseases. To children, the dilute hydro- 
chloric acid may be readily administered in lemonade or in sirup of 
lemons. 

There is no doubt of the value of the acids, especially the nitro- 
muriatic, in the treatment of constitutional syphilis. This remedy is 
not to be compared in efficiency with mercury and iodide of po- 
tassium, but in chronic cases saturated, so to speak, with these ap- 
proved remedies, in which syphilitic patches persistently reappear 
in the mouth, nitro-muriatic acid often renders important service. It 
is undoubtedly true that constitutional syphilis has been treated 
successfully by the acids alone, but a very rigidly abstemious dietary 
has been enforced in these cases. It has already been shown that 
the denutrition method is of itself sufficient in some cases to relieve 
the organism of constitutional infection. How much of the result 
is to be ascribed to the remedy, and how much to denutrition, is not 
clear. 

Nitric acid has been used with success in the treatment of inter- 
mittent fever by Hammond, Bailey, and others. In order to obtain a 
curative effect, it is necessary to give the acid in full doses every four 
or six hours. This acid is of great service, also, after an arrest of the 
paroxysms of intermittent by quinine, to remove the hepatic congestion 



MINERAL ACIDS. 109 

and the changes in the glandular apparatus of the intestines induced 
by the fever-movement. It may be advantageously combined with 
the bitters, or used instead of the aromatic sulphuric acid in the prep- 
aration of the official infusum cinchonm flavce. 

The mineral acids have long been used with more or less advan- 
tage in the treatment of phthisis. Their utility obviously depends 
on the fact that they supply to the digestive fluids a material in 
which they are deficient in this disease. As Fenwick has shown, 
both pepsin and acid occur in quantity much less than normal in 
the gastric juice of phthisical subjects. The acid best suited for the 
treatment of the indigestion of phthisis is the official acidum mu- 
riaticum dilutum. 

Nitric acid is one of the numerous remedies used in whooping-cough. 
It is frequently successful in shortening the duration of the disease and 
moderating its violence ; but it acts much more beneficially after the 
subsidence of the catarrhal stage. It should be given well diluted 
in sweetened water. Chronic bronchitis and hoarseness produced by 
singing and by simple acute catarrh are relieved by ten-minim doses 
of dilute nitric acid. 

The mineral acids, especially the hydrochloric, have lately been 
proposed as remedies for acute rheumatism. The unquestionable util- 
ity of the tincture of the chloride of iron in rheumatism lends support 
to this practice. It is highly probable that the mineral acids check 
the formation of lactic acid in the blood. Whatever may be the na- 
ture of the action, good results from the treatment have been reported 
(Dr. J. James Ridge). 

Some of the accidents due to lead are prevented, and relieved when 
they occur, by sulphuric acid. Sulphuric-acid lemonade is used by 
workmen in lead-factories to prevent lead-poisoning. This is supposed 
to act by forming the insoluble sulphate of lead. Dilute sulphuric 
acid is also effective in the treatment of lead-colic. The constipation 
due to lead is relieved by a combination of sulphuric acid and sulphate 
of magnesia, and the lead-cachexia is much benefited by a prescrip- 
tion of sulphate of quinine, sulphate of iron, and dilute sulphuric acid. 
The effects of lead on the nervous system are not removed by sul- 
phuric acid. 

Sulphuric acid is sometimes very effective in uterine haemorrhage. 
It has seemed to the author to be more useful in the case of haemor- 
rhage due to fibroid or polypus than the flow arising from other causes. 
Although sometimes prescribed for pulmonary hcemorrhage, it is not 
equal to other remedies. In intestinal haemorrhage sulphuric acid acts 
directly in part, and is therefore serviceable. In purpura it sometimes 
acts happily. 

The aromatic sulphuric acid has long been used to check profuse 
sweating, especially the siceating of phthisis. It is certainly service- 



110 RESTORATIVE AGENTS. 

able in this condition, but objectionable because of the ill effects of 
the acid on the function of digestion. If used at all, it should not in 
any case be long continued. 

Nitric and nitro-hydrochloric acids have also been used with ad- 
vantage in such diseases of the skin as lepra, impetigo, acne, erythema 
nodosum ; and sulphuric, internally and locally, is said to be very 
effective in lichen, prurigo, and itching conditions in general. 

In certain morbid states of the urine, as the phosphatic diathesis, 
oxaluria, alkalinity of the urine from disease of the urinary mucous 
membrane, and phosphatic calculus, the mineral acids render important 
service. In chronic cystitis and phosphatic deposits, a very weak solu- 
tion of nitric acid (gtt. j — 3 j) may be injected with advantage. In 
using such injections it is to be remembered that the bladder is ex- 
tremely intolerant, and hence they should be permitted to escape im- 
mediately. When uric acid is in excess in the urine from faulty diges- 
tion and assimilation, nitric acid is often of great service : the excess 
of uric acid disappears because the foods are more perfectly prepared 
for admission into the blood. 

Local ok Topical Uses of the Mineral Acids. — Some allusions 
have been made to the local application of muriatic acid in diseases of 
the throat and of the acid bath in hepatic affections. It will not be 
necesary to recapitulate on these points. 

Nitric acid is one of the most efficient escharotics for the destruc- 
tion of specific or unhealthy ulcers. It is the most frequently used 
caustic for the destruction of chancroid, sloughing or phagedenic 
chancre. A glass rod or bit of pine is dipped into the acid and ap- 
plied, care being taken to penetrate to all the sinuosities of the sore. 
The surrounding healthy tissue may be protected from injury by the 
previous application of oil, and, when the acid has sufficiently pene- 
trated, its further action may be arrested by some alkaline wash. A 
water-dressing, or spirit and water, or dilute tincture of benzoin, or 
some similar application, may be afterward applied to the sore. Ordi- 
nary indurated chancre does not require escharotic applications. Hos- 
pital gangrene, or a gangrenous condition of wounds, injuries, or 
ulcers, is similarly treated with advantage, and probably no form of 
caustic is more desirable than nitric acid for these purposes. Ordinary 
torpid and ill-conditioned idcers are improved and put in the way of 
healing by frequent washing with a weak lotion of nitric acid ( 3 j — 
Oj). The same solution will remove mucous patches and condylomata, 
and will often check the bleeding from hemorrhoids. 

Nitric acid is one of the means employed for the removal of haem- 
orrhoids. It is not effective, however, against all forms. Large 
haemorrhoids are much better treated by the ligature, galvano-caustic 
loop, or carbolic-acid injections. The so-called " strawberry-pile," a 
small hemorrhoid of red color, which consists of a congeries of arte- 



MINERAL ACIDS. HI 

rial twigs and which bleeds freely, can be effectually destroyed by 
nitric acid. The pile should be exposed, usually through a speculum, 
and the strong nitric acid be applied on a pine stick freely, followed 
by an abundant application of olive-oil to prevent the extension of the 
escharotic action to the surrounding parts. Small, superficial ncevi 
are treated successfully in the same way. 

Sulphuric acid penetrates more deeply than nitric, and its escha- 
rotic action is not so easily limited ; hence, it is not so frequently em- 
ployed for the destruction of sloughing and ill-conditioned ulcers. It 
is sometimes used in the form of Ricord's paste to chancres, sloughing 
or phagedenic. The paste is made by the addition of sufficient char- 
coal to strong sulphuric acid to give it the proper consistence. This 
is spread on a piece of muslin of a size equal to the sore, and is allowed 
to remain on until an eschar is produced, when an ordinary poultice 
may be applied. 

A favorite liniment of Sir Benjamin Brodie for counter-irritation 
of diseased joints is made by the addition of sulphuric acid to olive-oil 
( 3 j of the acid, § iv of olive-oil). 

A general bath in, or sponging the body with, a solution of nitro- 
muriatic acid — one ounce to a gallon — is very serviceable in the case 
of cachectic children who present these symptoms : a dry and wrinkled 
skin, sallow complexion, capricious appetite with a taste for dirt-eat- 
ing, and whitish, pasty motions. Applying to the surface of the body 
an acid solution, must affect the constitution of the blood, for an acid 
solution on one side of an animal membrane and an alkaline fluid on 
the other are the conditions most favorable to diffusion. 

Lately, Dr. Lombe Atthill, of Dublin, has called attention to the 
"use of nitric acid in the treatment of uterine disease." He applies 
the fuming nitric acid to the interior of the uterine cavity after pre- 
vious dilatation with sponge or laminaria tents. In order to protect the 
cervix and cervical canal he introduces an intra-uterine speculum with 
expansive blades. The cavity is first mopped out and dried with cot- 
ton ; then a probe, wrapped with cotton, is dipped in fuming nitric 
acid and applied thoroughly to the mucous membrane. This practice 
is very effective in the treatment of intra-mural fibroids and fungous 
granulations, to restrain haemorrhage, and after the removal of polypi. 
He almost invariably employs nitric acid in the treatment of granular 
cervicitis and endo-cervicitis, "with the best results." When decided 
tenderness of the uterus exists, he advises that this be first removed by 
suitable measures. 

Authorities referred to above : 

Atthill, Dr. Lombe. Obstetrical Journal of Great Britain and Ireland, June, 18*73. 
Bretonneau. Des Inflammations Speciales du Tissu Muquextx, et en particidier de la 
Diphtherite, Paris, 1826, p. 242, et seq. 

Fox, Dr. Wilson. The Diseases of the Stomach, Macmillan k Co., 1872, p. 140. 



113 RESTORATIVE AGENTS. 

Gfbler, Dr. Adolph. Commentaircs Therapeutiques du Codex Medicamentarius, Paris, 
1868, p. 464. 

Mackenzie, Dr. Morell. Pharmacopoeia of the Throat Hospital, p. 35. 

Martin, Sir Ranald. London Lancet, December 9, 1865. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimitiellehre, Berlin, 1870, p. 378, 
et seq. 

Ridge, Dr. J. James. The Medical Times and Gazette, vol. ii, 1871. 

Ringer, Dr. Sidney. A Handbook of Therapeutics, third edition, p. 97, et seq. 

Squire. Companion to the British Pharmacopoeia, 1871, p. 12. 

OILS AND FATS. 

Adeps. — Lard. Saindoux, Fr. ; /Schweineschmalz, Ger. — Below the 
temperature of 86° Fahr. a soft solid. 

Adeps Benzoinatus. — Benzoinated lard. 

Sevum. — Suet. Suif de mouton, Fr.; Schopsentalg, Ger. The pre- 
pared suet of ovis aries. 

Oleum Amygdalae expression. — Almond-oil. Huile d^amandes, Fr. ; 
Mandelnbl, Ger. The fixed oil obtained from the kernel of the fruit 
of the Amygdalus communis. 

Oleum Theobromce. — Cacao-butter. Beurre de cacao, Fr.; Cacao- 
butter, Ger. The concrete oil of the kernels of the fruit of Theobroma 
cacao. 

Oleum IAni. — Flaxseed-oil. Huile de Im, Fr. ; Leinol, Ger. The 
fixed oil obtained from Linum usitatissimum. 

Oleum Olivce. — Olive or sweet oil. Huile d' ) olive, Fr. ; Olivenol, 
Ger. The fixed oil obtained from the fruit of Olea JEuropcea. 

Oleum Gossypii Seminis. — Cotton-seed oil. A fixed oil expressed 
from the seed of Gossypium herbaceum, and subsequently purified. 
(Used in the preparation of linimentum ammonise ; linimentum calcis ; 
linimentum camphorae ; linimentum plumbi subacetatis.) 

Composition. — Lard is composed of 38 per cent of stearin and 
margarin and 62 per cent of olein, and olive-oil of 72 per cent of olein 
and 28 per cent of margarin. The more solid fats, as suet, contain 
much stearin. These neutral fats are, chemically, combinations of an 
acid (stearic, palmitic, margaric, oleic) with a base, glycerin. 

Petrolatum — [Vaseline ; cosmoline]. — A semi-solid substance, con- 
sisting of hydrocarbons, chiefly of the marsh-gas series. A yellowish, 
or yellow, fat-like mass, transparent in thin layers, completely amor- 
phous, tasteless, and odorless ; insoluble in water, scarcely soluble in 
alcohol, but readily soluble in ether, chloroform, oil of turpentine, etc. 

Oleum morrhuce. — Cod-liver oil. Huile de morue, Fr. ; Leber- 
thran, Ger. A fixed oil obtained from the fresh livers of Gadus mor- 
rhua, or of other species of Gadus. 

Composition. — Cod-liver oil contains a peculiar principle, gaduin, 
and yields, by distillation with ammonia, propylamin. It also differs 
from the fats and oils above described in containing various biliary 



OILS AND FATS. 113 

principles and traces of iodine, bromine, phosphorus, sulphuric and 
phosphoric acids, lime, magnesia, soda, and iron. It agrees with the 
other oils in being composed for the most part of olein and margarin. 
It is the latter constituent which gives the white cloudiness of cod-liver 
oil in cold weather, and which is, by the " British Pharmacopoeia," di- 
rected to be separated by artificial cooling. According to Winkler, 
cod-liver oil does not yield glycerin, but oxide of propyl, when saponi- 
fied. There are three varieties of oil, due, not to differences in com- 
position, but to modes of preparation : the pale, the light-brown, and 
the dark oil. The pale oil is freest from the products of decomposi- 
tion and empyreuma, is the best for internal administration, and is the 
official preparation. 

In order to obtain more positive therapeutical results, certain medici- 
nal substances are frequently added artificially to the cod-liver oils of 
commerce. Iodine, bromine, phosphorus, and iron, are thus added. Not 
only are such compounds bad, chemically considered, but the addition 
of such ingredients gives great opportunities for sophistication, and im- 
pure brown and other fish-oils may be substituted for the pure cod-liver 
oil. Besides, these combinations possess no therapeutical advantage. 

It has been supposed that any oil or fat, even glycerin, may be 
used in place of cod-liver oil, and cream has been prescribed in this 
belief. Linseed-oil has been considered to have some special efficacy in 
wasting diseases, more particularly in phthisis, because of the large 
amount of vegetable albumen which it contains. These notions are 
erroneous. Cod-liver oil has special therapeutical virtues because it 
contains gaduin, propylamin, the constituents of bile, iodine, phos- 
phorus, bromine, etc., in addition to the ordinary ingredients of an. 
animal fat. 

Physiological Actions. — An oil or fat applied by friction to the 
epidermis will disappear, and, as a positive gain may thus accrue, it is 
reasonable to suppose that not only absorption, but assimilation, also, 
has taken place. 

Fat plays an important part in the metamorphosis of animal fluids. 
As was long since shown by Lehmann, a small quantity of fat is essen- 
tial to the digestion of nitrogenous articles of food. Cod-liver oil, as 
well as other oils, when taken in the proper quantity, has the power to 
facilitate gastric digestion, and therefore promotes the appetite. Oil 
is a very important material in intestinal digestion — constitutes the 
molecular basis of the chyle, which consists chiefly of finely-divided 
fatty matter, each globule of fat being surrounded by a thin layer of 
albumen. The fat taken in with the food undergoes the emulsionizing 
process, chiefly in the small intestine, and by the aid of the pancreatic 
and biliary secretions. Cod-liver oil is, above all other fats, adapted 
to form the molecular basis of the chyle. All fats do not penetrate 
into the veins and lacteals with the same facility, and the presence of 
9 



114 RESTORATIVE AGENTS. 

certain substances is necessary to the process. Fats are not crystal- 
loidal but colloidal substances, and have, therefore, but a feeble power 
of osmosis ; but, notwithstanding this fact, the blood of the portal 
vein is much richer in fat than the blood of the arteries and systemic 
veins. The diffusion of fats is accomplished by the action of the bile. 
It was long since shown, by Wistinghausen, that in capillary tubes 
moistened by bile, oil will rise much higher than in tubes not so moist- 
ened, or when moistened with water or a saline solution. He also 
showed that oil will pass through membrane saturated with bile much 
more readily than through similar membrane saturated with water. 
It has been ascertained that, in dogs with biliary fistulas, the amount 
of fat in the chyle is much below the normal, and in the faeces much 
greater than normal (Day). Hence it must be concluded that the 
presence of bile is necessary to the absorption of fats, and that cod- 
liver oil must be peculiarly adapted to form the molecular basis of the 
chyle. It is for these reasons that, during a course of cod-liver oil, 
the body-weight is increased, the red blood-globules become more nu- 
merous, and a greater amount of fat is deposited in the tissues. It 
promotes the constructive metamorphosis. The important role per- 
formed by the oils and fats in the organism is shown by a variety of 
considerations. Wherever tissue-changes, physiological or pathologi- 
cal, are taking place, fat accumulates and enters largely into the for- 
mation of the resulting products. Newly-formed plasma contains 
much free fat, and all plastic exudations more than the non-plastic 
(Lehmann). Fat is the most abundant constituent of pus. 

Food is intended ultimately for two objects : first, to build up the 
tissues in the growing state and to reconstruct the tissues wasted by 
use ; second, to supply force, nervous, muscular, and digestive, to the 
different parts of the organism requiring it. The part performed by 
the fats is important as regards both objects. As already stated, they 
are essential to the construction of tissue ; modern researches have 
shown that they have a necessary office in the evolution of force. The 
well-known experiment of Fick and Wislicenus demonstrated that, on 
a diet of hydrocarbons, great muscular effort can be undergone with 
but little destruction of muscular tissue, and without increased urea- 
discharge. Turkish porters, who are remarkable for their great mus- 
cular strength and endurance, live on a diet composed of fat and rice. 
The acrobats of Japan, who live on a similar diet, grow to an enormous 
size, and accomplish feats of strength and agility to which the athletes 
of Western nations are hardly equal. 

If a muscle is made to contract under a bell-jar, an extraordinary 
evolution of carbonic-acid gas takes place, just as in violent muscular 
exercise the amount of carbonic-acid gas exhaled from the lungs is 
increased. 

Therapy. — Oils and fats are used by inunction in the treatment of 



OILS AND FATS. 115 

the scaly skin-diseases. A warm bath, if not contraindicated, may well 
precede the inunctions, and adeps benzoinatus, or suet, be then thor- 
oughly rubbed in. 

Inunctions of oil or fat promote constructive metamorphosis in such 
chronic wasting diseases as phthisis, scrofula, chronic dysentery, etc. 
The best oil for this purpose is cod-liver oil, but, as it stains the skin yel- 
low and has a disagreeable odor, it is often strongly objected to. Lard 
or suet benzoinated can be used, or may be perfumed to the taste of 
the patient. The best time for practicing the inunctions is just before 
retiring. A warm bath should first be taken, and then from one to two 
ounces may be rubbed into the skin. A thick night-garment should 
be put on to promote absorption and to prevent injury to the bedding.- 

Badly -nourished infants, rickety, or scrofidous, or suffering from 
chronic intestinal disorders, who have a dry and scaly skin, are often 
materially benefited by the tepid or warm bath, followed by inunc- 
tions of lard, suet, or almond-oil. Chlorotic girls, with or without dis- 
orders of menstruation, are improved in condition by the same means. 
Spare women, who wish to gain flesh and roundness of form, may have 
their wish gratified by warm baths and inunctions of oil. The im- 
provement which results from this practice is partly due to the gen- 
eral gain in bodily nutrition. 

Ruoeola, scarlatina, roseola, erysipelas, and other febrile diseases, 
are benefited by oil inunctions. These applications are grateful to the 
patient ; they allay the burning heat of the skin, and in this way dimin- 
ish restlessness and excitement. Inunctions of oil reduce the tempera- 
ture, but the decline in fever-heat is in part the result of the calmative 
influence which these applications have over one of the chief sources of 
distress. Inunctions of oil have a special utility in the desquamative 
stage of scarlet fever. It is the author's observation that inunctions of 
oil are serviceable in fevers generally, when there is much heat of skin 
and high temperature, with restlessness. Cocoa-butter is the most ele- 
gant of these preparations for external use, but lard benzoinated is the 
best. In the infectious diseases, a little carbolic acid may be added 
to the inunction oil or fat, with the view of destroying disease-germs. 

Those who experience frequent catarrhal attacks, and take cold on 
slight exposure, may have their susceptibility diminished by a daily 
application of oil to the whole surface of the body. 

In many maladies, the patients experience a notable distaste for 
fatty food in any form. This is especially the case with scrofulous 
and phthisical subjects, and, as fat in some form is necessary to di- 
gestion, assimilation, and heat-producing, it is obvious that by the use 
of cod-liver oil an essential element of nutrition may be supplied in the 
best form. In cases in which there exists a condition of faulty as- 
similation of fats, cod-liver oil, by reason of the fact that it contains 
in intimate association the bile elements, is especially adapted to form 



116 RESTORATIVE AGENTS. 

the molecular basis of the chyle. In scrofula, rickets, and other dis- 
orders of the nutritive functions belonging to this group, cod-liver oil 
is the best agent for promoting constructive metamorphosis. 

After scarlet fever in many children, especially in those with stru- 
mous diathesis, there occur discharges from the nose and ears, feeble 
digestion, and general emaciation. These sequelae of scarlet fever are 
best removed by the internal use of cod-liver oil. 

As a remedy in phthisis, cod-liver oil holds the first place, but it is 
not adapted to all forms and all stages of that disease. It is especially 
a remedy for the chronic forms of phthisis— fibroid lung and chronic 
tuberculosis — and is not serviceable in caseous pneumonia and acute 
phthisis. It is more useful in the chronic forms of phthisis because 
these afford the time and opportunity to reconstruct the tissues of the 
body — to build up the tissues from the molecular basis of the chyle. 
Cod-liver oil is not well borne when there is much fever, and can not 
be well assimilated when the stomach has undergone the alterations 
which belong to acute inflammatory affections. This remedy is too 
often prescribed without any reference to the condition of the pa- 
tient's digestive functions. The power of the stomach and intestines 
to digest fat is limited, and, if the quantity which can be disposed of 
is exceeded, the patient is incommoded. Rarely is it proper to pre- 
scribe more than a teaspoonful three times a day, and few patients 
can digest a tablespoonful. As the secretion of gastric juice, bile, and 
pancreatic juice, takes place most abundantly during the digestion of 
food, the time for the administration of oil in phthisical cases is after 
eating. When it is not well borne, the digestion and assimilation of 
the oil may be aided by combining it with liquor potassaB, lime-water, 
the compound tincture of gentian, tincture of nux vomica, or strychnine, 
or other correctives according to the indications in individual cases. 
When the oil is not well digested — although stomach disorder may 
not have occurred — and it is seen to float on the stools, it may be com- 
bined with ether, since Bernard has demonstrated that ether increases 
the production of pancreatic fluid. 

If continued for a sufficient length of time, cod-liver oil is of the 
greatest service in chronic bronchitis and emphysema. It should be 
given in the same way and under the same conditions as in phthisis. 

Chronic rheumatism and rheumatic arthritis, maladies for the re- 
lief of which cod-liver oil was first prescribed, when occurring under 
bad hygienic influences in cachectic subjects, may be much relieved 
by this agent. In addition to the internal use of the oil, it may be 
applied with advantage locally to the affected joints. This combined 
use of the oil, systemically and by local inunction, is to be commended 
in the so-called rheumatic gout with deposits about the joints. On the 
same principle, cod-liver oil is beneficial in cases of strumous syno- 
vitis, caries, and necrosis of bone dependent on a constitutional state. 



OILS AND FATS. 117 

It does not have, it must be admitted, any direct influence over these 
morbid processes ; but it enters most usefully into constructive tissue- 
metamorphosis. 

As a reconstituent, cod-liver oil is a very useful remedy in certain 
chronic affections of the brain and nervous system. One of the most 
common conditions with which we have to deal in middle and ad- 
vanced life, and also one of the most important as regards the integ- 
rity of the brain, is atheroma of the arteries. This condition is rep- 
resented by increased hardness of the radial pulse, the arcus senilis, 
irregular action of the heart, giddiness, vertigo,*partial loss of vision, 
and failure of the memory and other intellectual faculties. Used to 
obviate these degenerative changes, and to prevent failure in the nu- 
trition of the brain, we have in cod-liver oil a remedy of real value. 
It should be given in small quantity, and continued for a long time. 
As a phosphorized fat plays an important part in the structure and 
functions of the cerebral tissues, we may imitate the processes of Na- 
ture and administer the phosphates, the hypophosphites, or the lacto- 
phosphate of lime, in combination with cod-liver oil. The author has 
seen excellent results from such a combined use of these agents. Dr. 
Anstie much insists on the use of fats, especially cod-liver oil, as a 
part of the diet of those suffering from neuralgia, paralysis agitans, 
epilepsy, mercurial tremor, and chorea. Dr. Radcliffe had previously 
pointed out the utility of fats and oils in the same affections, and all 
practical physicians familiar with the subject are now pretty well 
agreed as to the value of this practice. The special indications for 
cod-liver oil in these affections are faulty assimilation and a low con- 
dition of the nutritive functions. Fats and oils are, of course, contra- 
indicated in these nervous disorders when they occur in plethoric and 
overfed subjects, but such a state of things is exceptional. 

In diseases of the skin of strumous origin, cod-liver oil is, as Dr. 
Tilbury Fox remarks, "our sheet-anchor." Among these diseases are 
lupus, ecthyma, psoriasis, scleroderma, etc. The constitutional state 
requiring cod-liver oil is a lowered condition of the assimilative func- 
tions dependent on the strumous cachexia. The local use of the oil is 
certainly advantageous in these cases. Dr. Hughes Bennett strongly 
recommends the free application of the oil to favus and eczema im- 
petiginodes. 

The condition of debility and faulty assimilation which results 
from the prolonged treatment of syphilis with mercury and iodine is 
frequently remarkably improved by cod-liver oil. The syphilodermata, 
when occurring in cachectic subjects, are benefited by a persistent use 
of the same remedy. With the internal use of the oil may be con- 
joined inunctions. These are especially beneficial in the squamaz of 
syphilitic origin. 

Mode of Administration of Cod-Liver Oil. — As cod-liver oil is 



US RESTORATIVE AGENTS. 

extremely repugnant to many patients, it is desirable to prescribe it in 
as agreeable a form as possible. Washing out the mouth with raw 
whisky or brandy so far blunts the sensibility of the nerves as to per- 
mit the oil to be swallowed without difficulty as regards its taste. 
Quickly stirred up in a hot whisky-punch, it may be swallowed with- 
out appreciation of the taste of the oil. It may be taken on beer, the 
oil covered with the foam, and carefully prevented touching the glass. 
A wine-glass may be thoroughly moistened with ale or beer, and the 
dose of oil just enveloped in the beer, when it may be tossed into the 
throat without perceiving the taste of the oil ; or the oil may be taken 
in sufficient lemon- juice in the same way. It may also be taken in 
black coffee. A very good disguise is that of Carlo Paresi, by which 
it is made to have the odor and taste of coffee. To 400 parts of cod- 
liver oil are added 10 parts of animal charcoal and 20 parts of ground 
roasted coffee. The mixture is digested in a water-bath at a tempera- 
ture of 50° to 60° C, and after standing three days is filtered and put 
in well-stoppered bottles. It is said that 10 drops of chloroform to 
100 grammes of the oil will render it palatable. One part of essential 
oil of eucalyptus to 100 parts of pale oil makes a mixture in which the 
odor and taste of the oil are entirely extinguished. Two drachms of 
cod-liver oil may be mixed with a drachm each of compound spirits of 
lavender and brandy. Emulsions of cod -liver oil are now prepared 
with glycerin and yolks of eggs, and suitably flavored. The various 
emulsions with lime are also much prescribed. Cod-liver oil saponified 
by lime has been brought forward by Prof. Yan den Court, of Brus- 
sels, as a remedy of especial efficacy in phthisis. Lastly, cod-liver oil 
has been used instead of lard or butter in the preparation of rolls, 
which are readily eaten by children. The addition of ether to cod- 
liver oil promotes its digestion. Bernard long ago made the observa- 
tion that ether stimulates the pancreas and increases its secretion, thus 
contributing to the emulsionizing of the fats. The combination of ether 
and cod-liver oil has been especially urged by Dr. B. Foster. The 
committee of the New York Therapeutical Society report that the ad- 
dition of fifteen minims of ether to each half-ounce of oil enables the 
patient to take it, if it had previously disagreed. 

Authorities referred to : 

Anstie, Dr. Francis E. Neuralgia and the Diseases that resemble it, Macmillan & Co., 
London, 18*71. 

Bennett, Dr. J. Hughes. Oleum Jecoris Aselli as a Therapeutic Agent in Certain 
Forms of Gout, Rheumatism, and Scrofula, London, 1841. 

Day, Dr. George E. Chemistry in its Relation to Physiology and Medicine, London, 
1860, p. 174. 

Flint, Dr. Austin, Jr. The Physiology of Man, vol. ii, p. 372, New York, 1873. 

Gubler, Dr. Adolph. Commentaires Therapeutiqucs, etc., Paris, 186S, p. 156. 

Lehmann, Prof. C. G. Physiological Chemistry, Philadelphia, 1855, vol. i, p. 221, 
et seq. 



PHOSPHORUS. 119 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittel, Berlin, 1870, p. 661, et seg. 

Ranke, Prof. Dr. Johannes. G-rundzuge der Physiologie des Menechen, Leipzig, 1872, 
p. 289. 

Ringer, Dr. Sidney. Handbook of Therapeutics, p. 247. 

Simon, Dr. Franz. Animal Chemistry, Syd. Soc, vol. i, p. 206. 

Trousseau et Pidoux. Trait'e de Therapeutique et de Matiere Medicate, huitieme edi- 
tion, vol. i, p. 304. 

Williams, Dr. J. C. B. and Dr. Theodore. Consumption. 

PHOSPHORUS AND SOME OF ITS COMPOUNDS. 

Phosphorus. — Phosphore, Fr. ; Phosphor, Ger. A translucent, 
nearly colorless solid, resembling wax, without taste, but having a pe- 
culiar smell. Its specific gravity is 1*8. 

Oleum Phosphoratum. — Phosphorated oil. Prepared by dissolv- 
ing phosphorus in ether and almond-oil. One part of phosphorus to 
100 parts of the menstruum. Dose, Tiii — tt],v. 

Piluloe Phosphori. — Phosphorus pills. Each pill contains about 
y^-o grain. Phosphorus is dissolved in chloroform, and then mixed 
with powdered althea and acacia, glycerin, and water. The pills are 
coated with balsam of tolu. 

Tinctura Phosphori (not official). — Phosphorus, one grain ; absolute 
alcohol, five drachms ;. glycerin, one ounce and a half ; spirit of wine, 
two drachms; spirit of peppermint, two scruples. "Dissolve the 
phosphorus in the alcohol with a little heat ; at the same time warm the 
spirit and glycerin together. Mix the two solutions while hot, and add 
the spirit of peppermint on cooling. Dose, one half to one drachm." 

Tinctura Phosphori ^Jtherealis (not official). — Solution of phos- 
phorus in ether. Dose, five to ten drops in sirup. A solution of phos- 
phorus in chloroform, or bisulphide of carbon, may also be prepared 
for internal administration. Pills of phosphorus may be extempo- 
raneously made by mixing the bisulphide of carbon solution with 
some inert powder. The evaporation of the bisulphide leaves the 
phosphorus in a finely-divided state intimately incorporated with the 
powder. 

Zinci Phosphidum. — Phosphide of zinc. Dose, one twentieth to 
one tenth of a grain. It is best administered in pill-form made with 
conserve of roses. 

Synekgists. — Oils and fats favor the absorption of phosphorus, 
and should never, therefore, be employed in cases of poisoning by 
this agent. Arsenic, and in a feeble degree sulphur, are synergistic. 

Antagonists. — The chief chemical antidotes to phosphorus are 
hydrated magnesia, lime-water, powdered charcoal, and sulphate of 
copper. To this list must be added turpentine of a certain kind. 
Phosphorus is now frequently taken in the form of matches, the par- 
ticles of which do not readily dissolve in the stomach and intestinal 
juices. When pure phosphorus, in the sticks or cylinders in which it 



120 RESTORATIVE AGENTS. 

occurs in commerce, is swallowed, large masses may remain imbedded 
in the folds of mucous membrane, or, escaping solution, descend with 
the other contents of the canal. Considerable time may thus elapse 
from the ingestion of the poison until its action begins. Emetics, 
therefore, assume a high degree of importance, and the most service- 
able emetic is sulphate of copper, which is at the same time a chemical 
antidote (Eulenburg and Guttmann). Bamberger has shown that 
phosphorus reduces sulphate of copper to the metallic state, the first 
step in the process being the formation of phosphide of copper, and 
that the masses of phosphorus are surrounded by a layer of copper, 
preventing its evaporation. He therefore advises that an emetic dose 
of sulphate of copper be first administered. Emesis may be facilitated 
by giving hydrated magnesia, diffused in a quantity of tepid water. 
As catharsis is next in importance, the bowels should be thoroughly 
evacuated. After the emetic dose of sulphate of copper has acted 
efficiently, this antidote should be given in small doses as frequently 
as possible — about one twelfth of a grain every twenty minutes. As 
the irritability of the stomach may prevent sufficient retention of the 
sulphate, the carbonate of copper has been proposed as a substitute, 
although Eulenburg and Landois, in their experiments on animals, have 
been unable, by the exhibition of the latter, to prevent death in cases 
of phosphorus-poisoning. 

Unquestionably the most important chemical antidote is turpentine, 
the French acid turpentine, especially. Letheby was the first to note 
that the vapor of turpentine prevented the toxic action of the vapor 
of phosphorus, and that workmen employed in the match-factory at 
Stafford, who were protected by vials of turpentine worn about the 
neck, escaped necrosis of the maxillary bones and other deleterious 
effects. Dr. P. C. Andant next published cases indicating the anti- 
dotal power of turpentine, and M. Personne submitted the subject to 
experimental demonstration and confirmed the observations of Andant. 
As turpentine destroys the luminosity in the dark and arrests the es- 
cape of the vapor of phosphorus, M. Personne infers that it acts simi- 
larly as an antidote, that is, prevents the combustion of phosphorus in 
the blood and the consequent consumption of the oxygen. The author 
has collected forty-six cases of poisoning by phosphorus, in which tur- 
pentine was employed as the antidote, and of this number but four 
were unsuccessful (Kohler, Sorbets, Laboulbene, Schimpff, Lichten- 
stein, Rommeleare, Berthold, etc.). Rectified oil of turpentine is not 
antidotal. The acid French oil is the preparation which has been 
used with success. The experiments of Vetter on animals fully con- 
firm the results of clinical experience, for he found that, while the 
rectified oil of turpentine had no effect, the crude, acid, French tur- 
pentine was very efficient as an antidote. The action of the crude 
turpentine is a process of oxidation and combination by which phos- 



PHOSPHORUS. 121 

phorus is converted into phosphoro-terebinthinic acid — a spermaceti- 
like substance, without poisonous or irritating qualities, which is elim- 
inated by the kidneys, the urine having a camphoraceous instead of 
the violet odor due to turpentine itself. Although the crude French 
oil is to be preferred, it is probable that our common oil of turpentine, 
exposed to the air, will develop antidotal power, by absorbing and 
ozonizing oxygen. The vapor of turpentine acts in the same manner 
on the vapor of phosphorus. The change in the effects of phosphorus 
acted on by turpentine has been thoroughly worked out. Adminis- 
tered to dogs, from one to fifteen grains, this substance excited no 
nausea, did not impair the appetite, caused no change in the tissues, 
and was eliminated harmlessly by the kidneys. 

To sum up : In the treatment of poisoning by phosphorus, in any 
of the forms in which it is introduced into the stomach, an emetic 
of sulphate of copper should be promptly employed, and the bowels 
should be moved by hydrated magnesia. When the stomach is emp- 
tied, small doses of sulphate of copper may be administered, but pref- 
erably turpentine, which should be given as rapidly as possible in an 
emulsion of gum, carefully avoiding oil. To counteract the cardiac 
and general systemic depression, opium will become necessary. If 
phosphorus has entered the blood despite the use of the appropriate 
antidotes, and much injury to its corpuscular elements has resulted, 
transfusion can be employed with considerable confidence, since Jiir- 
gensen has succeeded in several instances in saving life by this ex- 
pedient. Direct transfusion of human blood, with or without previous 
withdrawal of some portion of the damaged blood, is the proper pro- 
cedure. 

Physiological Actions. — The vapor of phosphorus is highly irri- 
tating to the conjunctiva and to the broncho-pulmonary mucous mem- 
brane. If caries of the teeth exist, necrosis of the maxillary bones 
may be induced by the vapor ; but it is doubtful whether, as has been 
afiirmecl, such necrosis may occur when the teeth are perfectly sound. 
There is an obvious distinction between the local effects of the vapor 
of phosphorus and the disease of the osseous system, the result of the 
constitutional impression of this agent. 

In ordinary medicinal doses, phosphorus gives rise to a sense of 
warmth at the epigastrium, but, if the dose be large, decided heat and 
even burning are experienced, and tenderness of the epigastrium re- 
mains. Prolonged administration of full doses will excite considerable 
gastric disturbance, and a catarrhal state of the mucous membrane. In 
the process of the oxidation of phosphorus, hydrogen is evolved, which 
in its nascent state readily combines with a portion of phosphorus, 
forming phosphide of hydrogen, eructations of which constitute one of 
the disagreeable features in the administration of this remedy. The 
action of the heart becomes more frequent, and the cutaneous circu- 



122 RESTORATIVE AGEXTS. 

lation, especially, more rapid ; the body temperature rises somewhat ; 
the mental activity and the muscular power increase ; the menstrual 
flow grows more abundant, and in males aphrodisiac effects are experi- 
enced, and the urine and sweat are more abundantly excreted. Phos- 
phorus in small quantity promotes constructive metamorphosis, in- 
creases the activity of the vegetative organs, and is a natural excitant 
of the functions of animal life ; it enters largely into the formation of 
tissues, and is a necessary element in the phosphorized fat which holds 
an important position in the composition of the cerebral matter. The 
administration of phosphorus increases the excretion of urinary phos- 
phates. 

The effects of phosphorus in toxic doses have been elaborately stud- 
ied, both in fatal cases of poisoning, occurring in man, and by experi- 
ments on animals. The form in which it is swallowed affects the rate 
at which the action occurs. If taken in solution in oil, in ether, or in 
the paste used as a vermin-destroyer, the toxic symptoms appear more 
promptly than if match-heads or ordinary phosphorus has been swal- 
lowed. An interval of varying duration elapses from the ingestion of 
the poison until disturbance of the stomach ensues. This interval — 
one to three hours — is occupied by the solution and oxidation of the 
phosphorus. Then epigastric uneasiness, nausea, and vomiting, come 
on ; first, the contents of the stomach, and then mucus and bilious mat- 
ters being ejected. The vomiting, accompanied by considerable epi- 
gastric pain and tenderness, persists usually for several days, when it 
assumes a special character, owing to the presence of the so-called 
"coffee-grounds," or "black-vomit." At first the vomited matters 
have a distinct odor of phosphorus, and appear phosphorescent in the 
dark. After several days of vomiting these symptoms disappear, and 
there may then be more or less hcematemesis, as well as coffee-grounds, 
due to erosions of the mucous membrane (Wolfe). The condition of 
the intestines varies with the presence or absence of phosphorus in 
their contents. The stools may be simply pasty and grayish from the 
absence of bile, or they may contain mucus and blood, and appear 
phosphorescent in the dark. Accordingly, as they may or may not be 
irritated, will the symptoms be those of constipation, diarrhoea, or dys- 
entery. The very characteristic but not invariable symptom — jaundice 
— appears on the second to the fifth day after the reception of the 
poison. It is absent in one fourth of the cases, and may be absent, 
also, when there is considerable fatty degeneration of the liver (Wolfe, 
Alter). It presents the usual appearance of jaundice as it occurs in 
acute yellow atrophy. It does not attain the maximum at once, but 
it appears first as some yellowness of the conjunctiva, the urine also 
becoming dark and loaded with urates, at the same time. 

The chemical changes which phosphorus undergoes in the stomach, 
and the combinations by which it enters the blood, are as yet not fully 



PHOSPHORUS. 123 

explicable. That some phosphoric acid and phosphide of hydrogen 
are formed is certain. That the oil or fat in the stomach will dissolve 
some portion of the phosphorus, and thus facilitate its diffusion as 
phosphorus into the blood, is highly probable (Husemann and Marme). 
Phosphorus is also slightly soluble in water at about 100° Fahr., and 
in organic fluids, as the bile, to a greater extent (Hartmann). As in 
the oxidation of phosphorus, phosphorous and phosphoric acids, and 
phosphide of hydrogen, are products, it is certain that these exert a 
poisonous influence to a greater or less extent in the stomach (Lecor- 
che). A portion of the agent taken undoubtedly enters the blood as 
phosphorus, and the subsequent changes in tissue-metamorphosis are 
due to its presence in the blood, where it has been detected by Bam- 
berger and others. With the entrance of the poison into the blood 
the action of the heart increases, and the temperature rises, the fever 
having a remittent type (Mannkopff). Toward the end, however, the 
function of hsematosis and of tissue-metamorphosis are so depressed 
that the body-heat declines below normal. In other cases there is no 
fever at all, or it appears near the end. Very great weakness of the 
heart's action has usually been observed, and the pulse has been much 
accelerated, although in some instances it became very slow, descend- 
ing as low as 40. The damage done to the blood is shown in the 
haemorrhages which take place from the various mucous surfaces — from 
the nose, stomach, intestines, kidneys, uterus (menorrhagia and me- 
trorrhagia) — and into the areolar tissue, in the form of petechias and 
ecchymoses. A hemorrhagic diathesis develops, so that the bleeding 
from a simple wound, a leech-bite, etc., may become uncontrollable. 

The intellect may remain unimpaired, but usually there are restless- 
ness, with coma, sometimes noisy delirium, anaesthesia of the extremi- 
ties, paresis of the members, and, near the end, convulsions (Hermann). 

The poison entering the blood is eliminated chiefly by the kidneys. 
The changes occurring in the urine are of especial interest. No depart- 
ure from the normal occurs until the alterations in the composition of 
the blood, and the general steatosis, prepare the way. The urine is 
diminished in amount, contains albumen, blood, and sometimes fibrin- 
ous casts. When jaundice comes on, its appearance is first announced 
by the presence of bile-pigments and acids. Urea almost entirely dis- 
appears toward the fatal termination ; leucin and ty rosin are occa- 
sionally present, and a peptone-like substance ; but the peculiarity most 
distinctive is the large quantity of paralactic acid, especially in the 
fatal cases (Schultzen and Riess). 

The duration of the cases of phosphorus-poisoning is by no means 
uniform. Although the rule is that symptoms do not follow immedi- 
ately on the entrance of the poison into the stomach, there are cases 
in which pain, nausea, and vomiting do occur almost immediately, and 
the most formidable symptoms come on promptly. One case is re- 



124 RESTORATIVE AGENTS. 

ported in which death occurred within nine hours, and numerous cases 
have terminated in death at the expiration of forty-eight to seventy- 
two hours. But usually the cases are less acute, and death does not 
occur before the end of the first, second, or third week. It is impor- 
tant to bear in mind that death may take place unexpectedly, before 
the most severe symptoms manifest themselves (Naunyn) ; and that 
the absence of decided gastric disturbance does not necessarily in- 
dicate a mild case. When recovery takes place, the improvement is 
slow, and the duration more or less protracted. In cases observed by 
Schultzen, the swelling of the liver could be distinguished at the ex- 
piration of four weeks, although the jaundice and the haemorrhages 
had disappeared. 

The changes induced by phosphorus are eminently characteristic. 
In the stomach are found erosions of variable extent, often absent ; 
fatty degeneration of the epithelium ; and a gastro-adenitis, first de- 
scribed by Yirchow, and confirmed by subsequent observers, notably 
by Bernhardt, whence the membrane has a swollen, grayish, or yellow- 
ish color. The same state of the mucous membrane may exist in the 
intestine as well. The liver is much enlarged as a rule, but may be 
atrophied. In five of the sixteen cases studied by Wolfe the liver was 
atrophied, but this is probably a more advanced change, and is, there- 
fore, encountered in the most protracted cases. The color of the liver 
is usually a pale yellow, or it may present a deep yellow, the acini ap- 
pearing enlarged and distinct. The increased size of the organ, and 
the change in its appearance, are due to fatty degeneration of the he- 
patic cells and epithelium (Mannkopff) ; but, according to some other 
authorities, an interstitial hepatitis is also set up, which is especially 
well marked in chronic phosphorus-poisoning. The jaundice, it is 
agreed generally, is due to resorption of the bile, swelling of the bile- 
ducts and of the orifice of the ductus communis preventing the en- 
trance of the bile into the intestine. The presence of bile-pigments 
and acids in the urine supports this view, but it has also been main- 
tained that the jaundice is hematogenic from dissolution of the 
blood. 

The changes in the composition of the blood are numerous and im- 
portant : it is fluid, non-coagulable, its corpuscles altered in form, and 
it contains much fat (Mehu). There are numerous ecchymoses, es- 
pecially under the peri- and endo-cardium (noted in thirteen out of six- 
teen cases by Wolfe), under the capsule of the liver, and in other 
situations. Besides the alterations in the blood, the occurrence of 
ecchymoses is favored by fatty degeneration of the small blood-vessels 
and capillaries (Klebs). The heart is also the seat of an acute fatty 
degeneration, and its tissue is soft and easily torn. The spleen is en- 
larged, and the kidneys are also enlarged and fatty, the renal epithe- 
lium being crowded with oil-drops. 



PHOSPHORUS. 125 

Not every case exhibits ttie wide-spread changes above described. 
If death occur in a short time, within nine hours, as has been noted, 
not sufficient time will have elapsed to allow of universal steatosis. 
There may, indeed, be no characteristic morbid appearances under such 
circumstances. In other cases, the changes may be limited to the liver. 

Chronic poisoning by phosphorus presents some interesting features. 
It occurs in those who are exposed to the vapor, in workmen engaged 
in phosphorus-factories, and especially in the workers in match-facto- 
ries. Irritation of the bronchial mucous membrane, and to a less ex- 
tent of the gastro-intestinal, takes place, with the attendant symptoms 
of cough, loss of appetite, indigestion, constipation, failure of nutri- 
tion, etc. The most important change is that occurring in the maxilla, 
more especially in the inferior maxilla, which is both more severely and 
more frequently diseased. The lower jaw has been repeatedly re- 
moved for this phosphorus necrosis, which begins in carious teeth, 
develops into a periostitis, and ends in death of the bone. The alve- 
olar process only, or a part or the whole of the bone, may be cast off. 
Phosphorus increases the production of osseous tissue ; the spongy 
tissue is thickened, and the compact is rendered more dense. Exten- 
sive osteophytic formations take place in animals fed on it, and the 
marrow cavity of long bones may be much encroached on, even closed, 
by the deposit of new osseous material (Wegner). 

Therapy. — The author enjoins on his readers the necessity for cau- 
tion in the use of phosphorus. As this agent so readily induces an acute 
fatty degeneration, when taken in poisonous quantity, the propriety of 
its administration in large doses for long periods may be questioned. 

Phosphorus is indicated more especially in the nutritive failure of 
the osseous and nervous structures of the body. It is especially in 
nutritive failure of the osseous and nervous tissue that phosphorus is 
required. The original suggestion by Wegner of its probable utility 
in osteomalacia, or softening of the bones, has been acted on by Friese, 
who found it remarkably beneficial in some obstinate cases. It will 
prove useful, also, when this condition exists in rickets. That hitherto 
incurable malady — progressive pernicious ancemia — has in some in- 
stances been apparently arrested by the administration of phosphorus ; 
but it has failed in others. The observations of Fox, Broadbent, and 
others, as to the utility of phosphorus in lymphadenoma, are very en- 
couraging, the more especially as, hitherto, remedies have had little 
influence over this intractable malady. 

The physiological action of phosphorus in small doses in increasing 
mental activity finds a therapeutical expression in the use of its prep- 
arations in cerebral disorders. It is indicated in pathological states 
dependent on anaemia, and contraindicated in vascular congestion and 
excitement. Cases of wakefulness, dependent on cerebral anaemia and 
exhaustion, are often remarkably benefited by phosphorus in the form 



126 RESTORATIVE AGENTS. 

of the pill or tincture. It does not procure sleep in the way that 
chloral and bromide of potassium do. By the use of it in suitable 
states we supply to the cerebral substance a material which it requires 
for the healthy performance of its functions. It acts most beneficially 
in the cases of wakefulness in which the nutritive functions of the 
body are wanting in activity. The wakefulness of the aged, accom- 
panied with muscular cramps, feebleness of memory, giddiness, and 
trembling of the voluntary muscles on exertion, is improved by the 
preparations of phosphorus. Early decay of the mental powers, asso- 
ciated with atheromatous changes of the cerebral vessels, and conse- 
quent impaired nutrition of the brain, is benefited by minute doses of 
this agent. In these states, occurring in the aged, it is better to com- 
bine with the phosphorus, or to administer simultaneously, cod-liver 
oil. The author has seen good results from such a combination in 
paralysis agitans. Large doses of the medicine in these disorders of 
advanced life are improper and unsafe. The best results are obtained 
from the persistent use of minute doses. M. Delpech has obtained 
excellent results from the use of phosphorus in paralysis. It is ob- 
viously adapted to cases of chronic character in which all acute symp- 
toms have subsided. The paralytic symptoms which accompany ichite 
softening of the brain (local and circumscribed ansemia) have appeared 
to the author to be improved by the use of the phosphates, hypophos- 
phites, and lacto-phosphate of lime. 

The preparations of phosphorus are very serviceable in neuralgia. 
It is true Dr. Anstie, in his recent able work on neuralgia, expresses 
the opinion that " its utility is not very extensive or reliable." Rad- 
cliffe, Bradley, Broadbent, Mr. J. Ashburton Thompson, on the other 
hand, report cures in some obstinate cases. Mr. Thompson's experi- 
ence indicates that large doses are necessary to effect a cure. In his 
own words : " I now invariably begin by giving -fa of a grain every 
four hours, and this I conclude to be an average dose." The formula 
given under the title "Tinctura Phosphori" is Mr. Thompson's ; each 
drachm of it contains -^ of a grain of phosphorus. "With this solution 
he has treated successfully thirteen cases of neuralgia. Dr. Broadbent 
has given phosphorus with advantage in " epileptiform vertigo," neu- 
ralgia, and "nervous breakdown from overwork." 

"We have no remedy at present more efficient in the treatment of im- 
potence than phosphorus. In the physiological state, priapism is one of 
the results of its toxic action. It is, of course, adapted only to cases 
functional in character, and not to impotence from organic defect. 

According to Dujardin-Beaumetz, phosphorus is useful in that very 
protracted and troublesome disease, progressive locomotor ataxia, or 
posterior spinal sclerosis. Although the author has not observed any 
instances of cure of this affection by phosphorus, he has witnessed in a 
few instances decided amelioration. 



PHOSPHORUS. 127 

Phosphorus has lately been employed as a substitute for arsenic in 
the skin-diseases for which the latter is used — notably acne, %)soriasis, 
lupus. The author has seen excellent results from the use of the com- 
pound sirup of the hypophosphites in acne indurata. 

Authorities referred to in this article : 

Alter, W. Experimentelle Beitrage uber die Ursachen des Icterus bei Phosphorver- 
giftungen. Diss. Breslau. V. u. H., vol. i, 1867. 

Andant, Dr. P. E. Bull. Gen. de Therap., tome lxxv, p. 269. Ibid., tome lxxvi, p. 
273. 

Anstie, Dr. F. E. Neuralgia audits Counterfeits, London, 1871. 

Bamberger, H. ton. Wurzbl. rned. Ztschr., Band 7, 1. Full abstract in Virchow u. 
Hir sell's Jahresbericht for 1867, vol. i. 

Bennett, Dr. James Risdon. The Medical Times and Gazette, vol. i, 1861, p. 438. 

Bernhardt, M. Die Veranderungen des Magens nach Phosphorvergiftung. Virchow' s 
Archiv, Band 39, p. 23. 

Berthold, A. Archiv der Heilkunde, 1876, p. 258. 

Bradley, G. M. The British Medical Journal, October, 1872. 

Broadbent, Dr. W. H. The Practitioner, April, 1873, p. 230. 

Dusart, M. The Lancet, vol. ii, 1870, p. 122. 

Ebstein, Dr. Archiv der Heilkunde. Quoted in Schmidt's Jdhrbucher, vol. cxiv, 
p. 283. 

Eulenburg and Landois. Die Transfusion bei acuten Phosphorvergift. Centralblatt 
f. d. med. Wiss. Virchow u. Hirsch's Jahresbericht, 1867, vol. i. 

Hartmann, Jul. Zur acuten Phosphorvergift. Diss. Dor pat. Ibid., vol. i, 1867. 

Husemann, Th. and W. Marme. Ibid., vol. i, 1866. 

Kohler, II. Berlin, klin. Wochen., i, 1870, p. 5. Ibid., Wiener Presse, various num- 
bers, 1873. 

Laboulbene, Dr. Gaz. des Hopitaux, xlvi, 1879, p. 361, and Gaz. Hebdom., 1S74, 
xxxiii, p. 524. 

Lecorche, Dr. Archives de Physiologie Norm, et Path., tome ii, 1869. 

Lebert, H. and Wyss, 0. Etudes cliniques et experimentales sur Vempoisonnement aigu 
par le phosphor. Archives General de Medicine, September, October, November, and 
December, 1868. 

Munk und Leyden. Die acute Phosphorvergiftung, Berlin, 1865. A. Hirschwald. 

Personne, M. Bulletin General de Therapeutigue, tome lxxvi, p. 353. 

Radcliffe, Dr. C. B. The British Medical Journal, 1863, p. 489. 

Ranvier, Dr. L. Gaz. Med. de Paris, 27, 28, 1867. Recherches experimentales au 
sujet de V action du phosphor sur les tissus vivants, etc. 

Rommelaere, Dr. Du Traiiement de Vempoisonnement par le phosphore. Bull. Gen. 
de Therap., vol. lxxxii, p. 145. 

Senftleben, Dr. Virchow's Archiv, vol. xxxvi, p. 530. 

Schraube, Dr. Otto. Uebersicht neuer Mittheilungen uber acute Phosphorvergiftung. 
Schmidt's Jahrbucher, Band 136, p. 207. 

Sorbets, Dr. Bull. Gen. de Therap., vol. lxvii, p. 42. 

Thompson, J. Ashburton. The Practitioner, vol. ii, p. 13. 

Vetter, Dr. A. TJeber die acute Phosphorvergiftung und deren Behandlung. Virehoic's 
Archiv, Band 53, p. 168. 

Virchow, R. Der Zustand des Magens bei Phosphorvergiftung. Virchow's Archiv, 
Band 31, p. 399. 

Wegner, Dr. Georg. Der Einfluss des Phosphors auf den Organismus. Ibid., Band 
55, p. 11. 



128 RESTORATIVE AGENTS. 

Wolfe, Jean. Disser. Berolini; Full Abstract in Virchow u. Hirsch's Jahresbericht 
vol. i, 1S68. An Account of the Morbid Appearances in Sixteen Cases of Phosphorus- 
Poisoning, occurring in Berlin from 1861 to 1868. 

PHOSPHITES AND PHOSPHATES. 

Prepakations. — Syrupus Calcii Lacto-phosphatis. — Sirup of the 
lacto-phosphate of lime. Dose, a teaspoonful. Lactic acid has the 
property of dissolving freshly-precipitated phosphate of lime. 

Compound Sirup of the Phosphates (not official). — Parrish's chemi- 
cal food. Each drachm contains two and a half grains of phosphate 
of iron and one grain of phosphate of lime. 

Syrupus Hypophosphitum. — Sirup of the hypophosphites. Com- 
posed of hypophosphites of calcium, sodium, and potassium. Dose, a 
teaspoonful three times a day. 

Syrupus Hypophosphitum cum Ferro. — Sirup of the hypophos- 
phites with lactate of iron. Dose, a teaspoonful three times a day. 

Sodii Phosphas. — Phosphate of sodium. " Large, colorless, trans- 
parent, monoclinic prisms, speedily efflorescing on exposure to air, 
odorless, having a cooling, saline, and feebly alkaline taste, and a 
slightly alkaline reaction. Soluble in six parts of water at 60° Fahr., 
and in two parts of boiling water." Dose, one drachm to one ounce. 

Sodii Pyrophosphas. — Pyrophosphate of sodium. " Colorless, 
translucent, monoclinic prisms, permanent in the air, odorless, having 
a cooling, saline taste, and a slightly alkaline reaction. Soluble in 12 
parts of water at 60° Fahr., and in 1*1 boiling water ; insoluble in 
alcohol." Dose, half a drachm to half an ounce. 

Calcii Hypophosphis. — Hypophosphite of calcium. " Colorless or 
white six-sided prisms, or thin, flexible scales, of a pearly luster, 
permanent in dry air, odorless, having a nauseous, bitter taste and a 
neutral reaction. Soluble in 6*8 parts of water at 60° Fahr., and in 
six parts of boiling water." Dose, gr. ij — gr. x. 

Calcii Phosphas Praicipitatus. — Precipitated phosphate of lime. 
"A light, white, amorphous powder, permanent in the air, odorless, 
tasteless, and insoluble in water or alcohol." Dose, gr. ij — gr. v. 

Sodii Hypophosphis. — Hypophosphite of sodium. Small, colorless 
or white, rectangular prisms, or a white granular powder, having a 
sweetish, saline taste and a neutral reaction. Soluble in one part of 
water. Dose, gr. v — gr. x. 

Physiological Actions. — In the first edition of this work the 
phosphates were included in the same section with phosphorus. There 
is a strong argument in favor of this arrangement, based on the chem- 
ical reactions which ensue when phosphorus is introduced into the 
stomach. Phosphorus has a strong affinity for oxygen, and compounds 
are quickly formed in the stomach. It is probable, however, that some 
phosphorus enters the blood uncombined. The toxic activity of the 



PHOSPHITES AND PHOSPHATES. 129 

compounds of phosphorus is in inverse ratio to the amount of oxygen 
contained in the combination. This fact, which would be inferred 
a priori, has been experimentally proved. 

Physiological Actions of Phosphate of Lime. — There is no 
part of the body which does not contain, or does not yield on incinera- 
tion, phosphate of lime. It gives solidity to the osseous framework of 
the body, and, when too little is furnished during the growing period, 
rickets and mollifies ossium are the result. The demand made on the 
system of the mother for the supply of this essential material for the 
growth of the osseous structure of the foetus is so great that her frac- 
tured bones unite with difficulty. The bones of animals, fed on food 
deficient in phosphate of lime, soften. All the animal fluids contain 
this substance in solution : thus it is found in the blood, the saliva, the 
gastric juice, milk, urine, and in the intercellular fluid throughout the 
body. It accumulates wherever tissue-changes are rapidly taking place 
(Dusart). It is obviously very important to the nutritive processes of 
the body. 

As phosphate of lime is to a limited extent soluble in lactic and 
hydrochloric acids, it is evident that, administered by the stomach, 
diffusion into the blood must occur. Large amounts can not, however, 
be disposed of in this way ; hence small doses must be as effective, in 
the treatment of the maladies for which it is prescribed, as large ones 
— for all in excess of the quantity soluble in the free acids of the 
stomach must pass off with the fasces or form intestinal concretions. 

Physiological Actions of Phosphate of Sodium. — This salt is 
soluble in water in the proportion of four per cent. Hence it may be 
given in solution, and will readily diffuse through into the blood. In 
the dose of one ounce it acts as a laxative. As it has a saline taste 
similar to common salt, it may be given in soup or other food. It in- 
creases the alkalinity of the blood, according to Bocker, by causing a 
retention of the chloride of sodium. Phosphate of soda diminishes the 
excretion of urea, in part, it is supposed, by hindering the retrograde 
metamorphosis of tissue, in part by its interference with the process of 
digestion. It is a constituent of the blood in the normal state, and as 
it possesses the remarkable property of increasing the quantity of car- 
bonic acid which can be held in solution by any liquid, obviously we 
have in these facts an explanation of its influence over the excretion 
of urea. That it impairs digestion in large doses when administered 
in health may be admitted, but by removing morbid states of the mu- 
cous membrane the digestive function, in suitable cases, is directly 
promoted by its use, and the nutrition of the body generally, and the 
tone of the nervous system, improved. 

Therapy. — In cases of the so-called bilious sick-headache, phosphate 
of soda is a most useful laxative. A permanent cure of this very 
troublesome malady may be wrought by regulation of the diet, and by 



130 RESTORATIVE AGENTS. 

the long-continued use of this remedy. It is not pretended that cases 
of migraine, due to an affection of the nucleus of the fifth, may be thus 
cured. A large proportion of these cases are produced by a catarrhal 
state of the gastro-intestinal mucous membrane, which the phosphate 
of soda has the power to remove. For the same reason, it is a remedy 
of the highest utility in cases of. jaundice dependent on catarrh of the 
bile-ducts, this disease being secondary to the same process in the in- 
testinal mucous membrane. In these affections the phosphate of soda 
should be administered in a drachm dose (about one teaspoonf ul) three 
times a day, or more frequently. Children, who are frequently sub- 
jects of this disorder, do not require larger doses than ten grains to a 
scruple. In preventing inspissation of the bile and crystallization of 
cholesterin, and attacks of hepatic colic, the persistent use of the phos- 
phate of soda is rarely unsuccessful. It is not pretended that this 
agent can relieve the attacks of hepatic colic, and, indeed, it is useless 
at these times. Many cases of this disease, if not most of them, origi- 
nate in a catarrh of the duodenum, the transference of the catarrhal 
state by continuity of tissue to the gall-bladder, and the formation of 
a nucleus of mucus and bile, about which the cholesterin crystallizes. 
Phosphate of soda has the property to prevent the occurrence of these 
changes, and consequently to prevent attacks of hepatic colic. The 
author has found one scruple to drachm doses, administered for several 
months before each meal, extremely efficacious in a number of cases 
of this kind. The value of Vichy in this and kindred affections 
probably depends on the phosphate of soda contained in this mineral 
water. 

Many ill-conditioned children are found to pass pasty and white 
stools, showing the absence of bile, and are pale and ill-nourished not- 
withstanding an abundant supply of milk and a vigorous appetite. 
Ten grains of phosphate of soda, dissolved in the milk and given 
them several times each day, will often improve the intestinal di- 
gestion, change the appearance of the stools, and increase the nu- 
trition of the body. 

The phosphates are especially useful in diseases characterized by 
mal-nutrition. In rickets, mollities ossium, delayed union of fractures, 
early decay of the teeth in children, caries and necrosis of bone, in 
which the phosphate is needed to the repair and growth of the osseous 
structures, it may be supplied artificially. The phosphate of lime 
may be administered alone in these states, but is to be preferred in 
the form of the sirup of the lacto-phosphate, or of Parrish's phosphates. 
As a large consumption of the phosphate of lime takes place during 
suckling, the anaemia of the nursing mother may be most advan- 
tageously treated with the lacto-phosphate of lime or phosphates. 
The waste caused by suppuration, carbuncles, mammary abscesses or 
boils, may be best repaired by the same means. The constitutional 



PIIOSPHITES AND PHOSPHATES. 131 

cachexia produced by chronic bronchitis with profuse expectoration, 
leucorrhcea, and similar exhausting discharges, may be much improved 
by the phosphates, and with the general improvement of the bodily 
state there usually takes place an arrest of the local morbid process. 

The explanation of the therapeutical action of the phosphates in the 
diseases just mentioned is equally true of their use in phthisis. The 
utility of the hypophosphites in this disease is not any greater, for it is 
probably true that these preparations undergo oxidation in the stomach 
and pass to phosphates. The compound sirup of the hypophosphites 
is an agreeable preparation and is readily taken, and certainly proves 
serviceable in the more chronic forms of the disease. The lacto-phos- 
phate, the phosphates, and the hypophosphites, are undoubtedly useful 
in chronic phthisis, fibroid lung, chronic tuberculosis, emphysema, and 
dilated bronchi, but no advantage can be expected from them in acute 
tuberculosis and caseous pneumonia, and it has been asserted that phos- 
phate of lime — 5 grains ter die — has the power to stop the sweats of 
phthisis. If they improve the appetite, promote digestion, and increase 
the body-weight, they do good ; if they disagree with the stomach, they 
do harm (Bennett). Not unfrequently the sirup of the hypophosphites 
gives rise to distressing tormina. This may be obviated by combining 
with it dilute phosphoric acid — a combination very effective, therapeu- 
tically : t> Syrp. hypophos. comp., § iijss ; acid, phosphor, dil., \ ss. M. 
S. : A teaspoonful three times a day. Such a combination may be 
advantageously given with cod-liver oil, after meals, in chronic phthisis. 
The addition of arsenic contributes very materially to the therapeutical 
effects of the lacto-phosphate ; for example : $ Syrp. calcii lacto-phos., 
| iv ; liq. potassii arsen., 3 j. M. S. : A dessertspoonful ter die. 

Late favorable reports regarding the curative effects of phosphorus 
and its compounds in pernicious anosmia have not been confirmed by 
the most recent experience. 

Percy, who has made some useful researches on phosphorus, pre- 
pares hypophosphorous acid by passing through a solution of phos- 
phorus in oil, perfectly pure and dry oxygen. He maintains that hy- 
pophosphorous acid is the only preparation of phosphorus which should 
be employed in medicine. 

Further experience with the phosphate of soda justifies the author 
in the expression of his belief that it has the power to retard the growth 
of the changes known as sclerosis of the liver, and possibly, under 
favorable circumstances, to arrest them and to restore a comparatively 
normal functional state. When, in obese subjects, a succession of boils 
portends the development of diabetes, this remedy is highly useful 
especially when combined with the arseniate of soda. It has seemed 
very beneficial in the hepatic form of diabetes. No remedy is more 
effective in removing that condition of the system which produces 
furuncles, or boils. 



132 RESTORATIVE AGENTS. 

IRON AND ITS PREPARATIONS. 

Fermm. — Fer, Fr. ; Fisen, Ger. " In the form of fine, bright, non- 
elastic wire." 

Fcrrum Beductum. — Reduced iron. Ferri pulvis. A tasteless 
powder of an iron-gray color. Dose, gr. ss — gr. ij. 

Ferri Carbonas Saccharatus. — Saccharated carbonate of iron. A 
greenish-gray powder, odorless, having at first a sweetish, afterward 
a slightly ferruginous taste. It is only partially soluble in water. 
Dose, gr. ij. 

Trochisci Ferri. — Troches of hydrated oxide of iron. Composition : 
Hydrated oxide of iron, vanilla, sugar, and mucilage of tragacanth. 
Dose, one to five. 

Ferri Oxidum Hydratum. — Hydrated oxide of iron. Kept in the 
form of a soft magma and used as an antidote to arsenic. 

Ferri Oxidum Hydratum cum Magnesia. — Hydrated oxide of 
iron with magnesia. (For arsenical poisoning.) 

Pilular Ferri Compositor. — Compound pills of iron. Composition : 
Myrrh, carbonate of sodium, sulphate of iron. Dose, one or two pills. 

Massa Ferri Carbonatis. — Mass of carbonate of iron (Vallet's 
mass). Sulphate of iron, carbonate of sodium, honey, sugar, etc. Dose, 

g r - iij — g r - v - 

Mistura Ferri Composita. — Compound mixture of iron. Compo- 
sition : Myrrh, sugar, carbonate of potassium, sulphate of iron, spirit 
of lavender, rose-water. Dose, a tablespoonful. 

Emplastrum Ferri. — Iron-plaster, strengthening-plaster. Compo- 
sition : Subcarbonate of iron, lead-plaster, and Burgundy pitch. 

Ferri Hypophosphis. — Hypophosphite of iron. A white or gray- 
ish-white powder, odorless and nearly tasteless, only slightly soluble 
in water. 

Ferri Phosphas. — Phosphate of iron. A bright, slate-colored pow- 
der, insoluble in water. Dose, gr. ij — gr. v. 

Ferri Pyrophosphas. — Pyrophosphate of iron. In apple-green 
scales, having an acidulous, slightly saline taste, and wholly soluble 
in water. Dose, gr. ij — gr. v. 

Ferri Sidphas. — Sulphate of iron. In transparent, bluish-green 
crystals, which, on exposure to the air, effloresce and change color. Is 
wholly soluble in water. Dose, gr. j — iij. 

Ferri Sulphas Fxsiccatus. — Dried sulphate of iron. A grayish- 
white powder, soluble in water with the exception of a small residue. 
Dose, gr. j— gr. ij. 

Ferri Sulphas Prmcipitatus. — Precipitated sulphate of iron. A 
pale, bluish-green powder ; oxidizes in contact with moisture ; solu- 
ble in 1*8 part of water at 60° Fahr. Dose, gr. ij — gr. v. 

Liquor Ferri Subsulphatis. — Solution of subsulphate of iron. Mon- 



IRON. 133 

sel's solution. Composition : Sulphate of iron, sulphuric acid, nitric 
acid. An inodorous, sirupy liquid, of a ruby-red color, and of an ex- 
tremely astringent taste, without causticity. It mixes with water and 
alcohol, in all proportions, without decomposition. 

Liquor Ferri Tersulphatis. — Solution of tersulphate of iron. Com- 
position : same as preceding preparation, except the quantity of acid. 
A dark, reddish-brown liquid, nearly devoid of odor, and of an acid 
and extremely styptic taste. 

Ferri Chloridum. — Chloride of iron. In orange-yellow, crystal- 
line pieces, very deliquescent, and wholly soluble in water, alcohol, 
and ether. Dose, gr. j — gr. ij. 

Liquor Ferri Chloridi. — Solution of chloride of iron. 

Tinctura Ferri Chloridi. — Tincture of chloride of iron. Compo- 
sition : Solution of chloride of iron, alcohol. Dose, irj, v— ttj, xx. 

Liquor Ferri JVitratis. — Solution of nitrate of iron. A transparent 
liquid, having a pale amber color. Dose, in, ij — u], v. 

Syrupus Ferri Lodidi. — Sirup of iodide of iron. A transparent 
liquid of a pale-green color. Composition : Iodine, iron, sirup. Dose, 
TTl x — tii l x « 

Filulce Ferri Lodidi. — Pills of iodide of iron. Composition : Iodine, 
iron, sugar, liquorice, and gum-arabic. Dose, one to three pills. 

Ferri Lodidum Saceharatum. — Saccharated iodide of iron. Dose, 
gr- j— gr- v. 

Ferri Citras. — Citrate of iron. " Transparent, garnet-red scales, 
odorless, and having a very faint ferruginous taste and an acid reac- 
tion ; slowly but completely soluble in cold water. 

Ferri et Ammonii Citras. — Citrate of iron and ammonium. In 
garnet-red, translucent scales, having a slightly ferruginous taste, and 
readily and wholly soluble in water. Dose, gr. ij — gr. v. 

Ferri et Arnmonii Sulphas. — Sulphate of iron and ammonium. 
Ammonio -ferric alum. In octahedral crystals of a pale violet color, 
soluble in one and a half part of water at 60°. Dose, gr. j — gr. ij. 

Ferri et Ammonii Tartras. — Tartrate of iron and ammonium. In 
transparent garnet-red scales, which have a saccharine taste. It is 
slowly soluble in rather more than its weight of water, but insoluble 
in alcohol and ether. Dose, gr. ij — gr. v. 

Ferri et Potassii Tartras. — Tartrate of iron and potassium. In 
transparent scales, of a dark ruby-red color, and wholly soluble in 
water. Dose, gr. ij — gr. v. 

Ferri et Quininm Citras. — Citrate of iron and quinia. In thin, trans- 
parent scales, reddish or yellowish brown. Taste ferruginous and bit- 
ter. Slowly soluble in cold, more readily in hot water, and not soluble 
in alcohol and ether. Dose, gr. j — gr. v. 

Liquor Ferri et Quinince Citratis. — Solution of the citrate of iron 
and quinine. Contains 6 per cent of quinine. 



134 RESTORATIVE AGENTS. 

Ferri et Strychnince Citras. — Citrate of iron and strychnine. Con- 
tains one grain of strychnine to 100 grains of the compound. Dose, 
gr. j— gr. iij. 

Liquor Ferri Acetatis. — Solution of acetate of iron. 

Tinctura Ferri Acetatis. — Tincture of acetate of iron. A clear, 
dark, reddish-brown liquid, having the odor of acetic ether, an acidu- 
lous and astringent taste, and mixes with water in all proportions. 
Dose, tti x to 3 ij. 

Ferri Lactas. — Lactate of iron. In greenish - white crystalline 
crusts or grains, of a mild, sweetish, ferruginous taste, soluble in 
forty-eight parts of cold water, but insoluble in alcohol. Dose, gr. 

Ferri Oxalas. — Oxalate of iron ; a lemon-yellow, crystalline pow- 
der, insoluble in water. Dose, gr. ij — gr. v. 

Vinum Ferri Amarum. — Bitter wine of iron (solution of citrate 
of iron and quinine, tincture of sweet orange-peel, sirup, and stronger 
white wine). Dose, a teaspoonful to a tablespoonful. 

Vinum Ferri Citratis. — Wine of citrate of iron. Dose, a tea- 
spoonful to a tablespoonful. 

Mistura Ferri et Ammonii Acetatis. — Basham's mixture. Dose, 
| ss — | j. Consists of tinct. chloride iron, dil. acetic acid, sol. acetate 
ammonia, elix. orange, sirup, and water. 

Unofficial Formulae. — Ferri Arsenias. — Arseniate of iron. A 
tasteless powder of a green color, insoluble in water, but soluble in hy- 
drochloric acid. Dose, gr. -^ — gr. J. 

Syrupus Ferri et Mangani Iodidi. — Sirup of the iodides of iron 
and manganese. Dose, 3 j. 

Mistura Ferri Aromatica. — Composition : Pale bark in powder, 
4 ; calumba, in powder, 2 ; cloves, bruised, 1 ; iron wire, 2 ; compound 
tincture of cardamoms, 12 ; tincture of orange-peel, 2 ; peppermint- 
water, 50 ; macerate the first four ingredients in the last one for three 
days, agitating occasionally, filter, add the tinctures, and make up to 
50. Dose, % j — ij (Squire). 

Syrupus Ferri et Mangani Phosphatis. — Sirup of the phosphate of 
iron and manganese. Dose, 3 j. 

Mistura Ferri Laxans. — Composition : Sulphate of iron, 2 grains ; 
sulphate of magnesia, 1 drachm ; dilute sulphuric acid, 3 minims ; 
spirit of chloroform, 20 minims ; peppermint-water, to 1 oz. (Squire). 

Ferrum Dialysatum. — Dialyzed iron. This preparation is made by 
the process of diffusion, and is iron in the colloid state. It is odorless, 
without the styptic taste of the ferruginous preparations, does not 
blacken the tongue and teeth, is free from irritant action, and does 
not constipate. It is precipitated by sulphuric acid, by acids, and by 
various salts, but neither by alcohol nor sugar. It is doubtful whether 
it be a good form in which to administer iron. Dose, niv — 3 j. If 



IRON. 135 

any given preparation has a styptic taste, and acts on the tongue and 
teeth, it is not genuine. 

Reduced iron is one of the most useful ferruginous preparations for 
internal administration, comparatively tasteless, and therefore easy of 
administration, and readily soluble in the juices of the stomach. The 
objection to its use is the occurrence of eructations, sulphureted or 
phosphureted, owing to the oxidation of the iron, the evolution of 
hydrogen, and the combination of the nascent hydrogen with sulphur 
or phosphorus. 

The so-called subcarbonate of iron is really little more than the red 
oxide. In the official pilulae ferri carbonatis, the oxidation of the iron 
and the loss of carbonic acid are prevented by the sugar. This prepa- 
ration is very soluble in the stomach-juice, and is readily assimilated. 
The troches of carbonate of iron are convenient for administration to 
children, who take them readily. The hydrated oxide of iron is solely 
used as the antidote to arsenic in solution. For remarks on its admin- 
istration I have to refer the reader to the article on Arsenic. Corre- 
sponding to these carbonates are the pilulae ferri compositae, which 
contain iron in the form of the carbonate, sulphate of soda, and myrrh. 
The mistura ferri composita is also a solution of the carbonate, con- 
tains myrrh and sulphate of potash, with a sufficient quantity of the 
latter to form an emulsion which suspends the iron. 

Of the phosphates the better preparation is the pyrophosphate, 
which is readily soluble, unirritating, and easily assimilable. The sul- 
phate is an active astringent, and is an efficient remedy. When pre- 
scribed in pillular form the dried sulphate should be used, as the sul- 
phate in efflorescing destroys the cohesion of the mass. Of the several 
solutions intended for topical use, the liquor ferri subsulphatis, or 
Monsel's solution, is the best, as it is powerfully styptic without being 
corrosive. The tincture of the chloride of iron is most agreeably taken 
in the form of Creuse's tasteless preparation, which appears to be an 
efficient chalybeate without possessing the causticity of the pharma- 
ceutical preparation. In the sirup of the iodide of iron and the sirup 
of the iodides of iron and manganese, sugar is used to prevent oxida- 
tion of the iron and the setting free of the iodine. In the iodide-of- 
iron pill the same result is obtained by sugar or gelatin coating. 

Less irritating to the stomach, but probably less efficient as chalyb- 
eates, are the combinations of iron with vegetable acids. These may 
be administered dissolved in Rhine, Catawba, or sherry wine. An 
elegant mode of prescribing them is in effervescence — the citrates or 
tartrates dissolved in a solution of citric or tartaric acid, and poured 
into a solution of sodium or potassium bicarbonate — to be drunk in 
effervescence. 

Antagonists and Incompatibles. — The carbonates are incompati- 
ble with acids and acidulous salts and vegetable astringents ; the 



136 RESTORATIVE AGENTS. 

citrates and tartrates with mineral acids, alkalies and their carbonates, 
tannic acid ; the iodides with acids, acidulous salts, alkalies and their 
carbonates, lime-water, vegetable astringents ; the tincture of the 
chloride, with alkalies and their carbonates, lime-water, carbonate of 
lime, magnesia and its carbonate, and astringent vegetables turn it 
black. 

Synergists. — All agents promoting constructive metamorphosis are 
synergistic to iron, especially animal aliment, the simple, aromatic, and 
astringent bitters, cinchona, manganese, bismuth, etc. 

Physiological Actions. — Although metallic iron is inert, yet in 
the stomach it enters into combination dissolved in the acids, and 
then acquires molecular activity. As a result of its oxidation in the 
stomach, hydrogen is liberated, which in its nascent state combines 
with sulphur, forming sulphureted hydrogen. In part, iron is ab- 
sorbed by the stomach, probably as an albuminate ; in part, in the 
intestinal canal. The stools under a course of iron become brownish 
and even black, a result which indicates that a part of the metal taken 
fails to be absorbed ; but, since it has been shown that, whether taken 
by the stomach or injected into the blood, elimination takes place by 
the intestinal canal, it remains uncertain how much is excreted or is 
merely discharged unaltered in the faeces. 

Iron is not a substance foreign to the organism. Chemical analysis 
has demonstrated its constant presence in the blood, in the gastric juice, 
chyle, lymph, bile, in the pigment of the eye, and in traces in the milk 
and urine. According to Gorup-Basanez (analysis of C. Schmidt), the 
blood of man contains one part of iron to 230 of red globules, and that 
of beef one part of iron to 194 of red globules. Iron exists in com- 
bination in hsematin ; according to some in the state of oxide, accord- 
ing to others as metallic iron. That it performs a very important office 
is shown in the rapid construction of red blood-globules when iron is 
administered in anaemia. Without it hsematin is not formed, and the 
red globules diminish in number. By its medicinal use we furnish to 
the blood a material which it needs. In health a mixed diet contains 
sufficient iron for all the purposes of the economy. The blood being 
improved in quality by the administration of iron, the tissues are better 
nourished, and all the functions are performed with more vigor. 

The physiological action of iron is not limited merely to the con- 
struction of red blood. When there is no intolerance to its presence 
in the stomach, it promotes the appetite and invigorates the digestion. 
By increasing the disposition for food and the ability to dispose of it, 
iron acts as a stomachic tonic. Hence, when given in the healthy 
state, or when administered for too long a period in disease, the gas- 
tric glands become exhausted by over-stimulation, and then it is said 
the iron disagrees. Being a restorative, its use is contraindicated in a 
condition of plethora, especially when there exists a tendency to hoem- 



IRON. 137 

orrhage, or when there is reason to suspect an atheromatous state of 
the cerebral vessels. 

In large doses the soluble preparations of iron give rise to nausea 
and vomiting. Some of them possess more or less toxic activity ; the 
per-salts are more active than the proto-salts. The iodide and chloride, 
the nitrate and sulphate, are the most active, death having ensued 
from the tincture of the chloride in one case (Christison), and alarm- 
ing symptoms having occurred in others (Taylor). 

Certain of the salts of iron, the sulphates, the nitrates, the chlo- 
rides, possess a high degree of astringency. Hence they produce con- 
stipation when taken internally. Brought into contact with blood, 
they coagulate it, forming a tough, brownish magma ; and, as the al- 
buminous elements of the tissues are also solidified, they are powerful 
haemostatics. 

Iron is eliminated by several channels. Its passage down the in- 
testinal canal and exit by this route have already been alluded to. As 
the experiments of Lussana have shown, a large part of the iron which 
enters the portal circulation is eliminated by the liver in the bile, and 
this view is further supported by the recently made investigations of 
Zaleski, of Dorpat. But a small part of the iron taken, therefore, 
finally enters the systemic circulation, and of this, the part unappro- 
priated in tissue or blood-globule formation is finally eliminated by 
the kidneys. 

The acid and astringent preparations of iron act on the teeth with 
considerable energy, as the experiments of Dr. Smith (of Edinburgh) 
prove. 

The tincture of the chloride and the sulphate are more corrosive 
than the wine, and of course are more injurious than the compounds 
of iron with the vegetable acids. 

Therapy. — Iron-spray — a weak solution of the liquor ferri subsul- 
phatis ( 3 j — 1 viij) — is very serviceable as an astringent in obstinate 
cases of epistaxis. The nozzle of the delivery-tube of the spray-douche 
should be inserted just within the anterior nares, and the spray be 
driven with considerable force. The same application is beneficial in 
chronic coryza, but the objection to its use is the danger of coloring 
the teeth. In pulmonary hemorrhage, the same application made to 
enter the throat with the inspired air will often arrest the flow of blood ; 
and this, notwithstanding so little iron can pass the chink of the glottis. 

The subsulphate and pernitrate solutions are the most efficient 
remedies for arresting hcsmatemesis. They should be given in small 
doses — one or two drops, well diluted with ice-water, and frequently. 
In the absence of these, the tincture of the chloride may be used in the 
same way. In intestinal hemorrhage the astringent preparations of 
iron are much less beneficial, if, indeed, they serve any useful purpose 
— for they are converted into inert sulphides as they descend the canal 



13S RESTORATIVE AGENTS. 

The author has seen the intestinal haemorrhage of typhoid fever much 
increased by the rectal injection of a solution of Monsel's salt. The 
bleeding from hemorrhoids may be much diminished and even arrested 
by washing the tumors, when they protrude, with the solution of the 
subsulphate. After the application of the iron, the tumors should be 
well oiled before returning them into the rectum. The solution of the 
pernitrate of iron has been very efficacious as an astringent in chronic 
diarrhoea and dysentery, in that known as the army diarrhoea. These 
diseases, as they occur in civil practice, may sometimes be arrested by 
this agent, but not usually, in the author's experience. A solution of 
the tincture of iron is one of the numerous remedies used to destroy 
the ascarides vermiculares — the thread-worms which infest the rectum. 
As the development of these parasites is favored by the anaemic state, 
it is good practice to conjoin with any local treatment the internal use 
of iron, notably the sirup of the iodide. 

Iron is frequently given with advantage to promote appetite and 
digestion merely. Indeed, it is the opinion of some eminent authori- 
ties that the chief use of iron as a remedy, even in anaemia, is to pro- 
mote the digestive function. For the purpose of increasing appetite 
and energizing digestion, the sulphate is the best chalybeate, unless, 
indeed, the mucous membrane prove intolerant. When digestion is 
feeble, and the intestinal movements sluggish, it is often advantageous 
to combine aloes with iron, as in the official aloes-and-iron pill, or with 
sulphate of magnesia, as in the mistura ferri laxans, the formula for 
which has been given. 

The condition most usually requiring iron is anamiia, a deficiency 
not only of the haematin but of the red corpuscles. Iron is given in 
this state with the view of supplying to the organism a material in 
which it is deficient, and in this way promoting the construction of the 
red globules. As, however, food, especially beef, is rich in iron, and 
as but a small amount of that administered is really assimilated, there 
is much reason for holding that at least an important function of iron 
in anaemia consists in its power to promote appetite and digestion. 
Practical physicians are familiar with the fact that iron improves but 
little, if at all, the condition of the anaemic, when it does not increase 
the desire for food and the ability to digest it. In anaemia, iron is 
given with two objects : to furnish a needed material to the blood ; to 
increase the energy of the primary assimilation. To accomplish the 
first object, small doses — one or two grains — of reduced iron or of the 
carbonates, or some one of the combinations with vegetable acids, are 
most suitable. The second object is best attained by the more active 
astringent preparations, especially the sulphate and the chloride. Large 
doses of these are frequently well borne. When they disagree, other 
salts may be tried, but preference should be given to the most astrin- 
gent preparation which the patient's stomach will tolerate. 



IRON. 139 

In chlorosis, the good effects of iron are not so conspicuous as in 
anaemia, although they are allied states. During a course of iron in 
chlorosis, purgatives are now and then necessary. Better results are 
obtained from a combination of iron and arsenic, and iron and strychnine, 
than from iron alone. The arseniate of iron is an excellent remedy in 
chlorosis, but it must be given in larger doses than the posological 
tables authorize, for it is by no means so actively toxic as is commonly 
supposed. A good formula is the following : 3 Ferri arseniat., gr. 
ij ; ext. cinchona?, gr. xij. M. Ft. pil. no. xij. Sig. : One three times 
a day after meals. 

In anaemia and chlorosis, the iron should be taken after meals to be 
mixed with the food. The preparations of iron should not be continued 
too long ; occasional intermissions in their use are necessary, otherwise 
the digestive organs become deranged, and the good effects are lost. 
Occasional purgation is useful, and acts in a way to favor the absorp- 
tion and assimilation of the iron. Air and exercise should always, if 
practicable, be prescribed in a ferruginous course, for the assimilation 
of iron is directly favored by these hygienic influences. 

The ancemia of chronic malarial poisoning is especially improved 
by iron. If enlargement of the spleen and engorgement of the portal 
circulation co-exist, the use of the compound jalap-powder should pre- 
cede the iron ; or the latter may be combined advantageously with 
resin of podophyllin, as follows : fy Quininae sulphat., 3 j ; resinae 
podophylli, gr. iv ; ferri sulphatis exsic., 3 j. M. Ft. pil. no. xx. 
Sig. : One or two pills three times a day. 

According to some, massa ferri carbonatis is preferable to the 
sulphate ; it is certainly sometimes better borne. ^ Mas. ferri carbo- 
natis, 3 j ; acidi arseniosi, gr. j ; quininae sulph., 3 ij. M. Ft. pil. no. 
xl. Sig. : Two pills three times a day. In enlarged spleen of malarial 
origin, a combination of sulphate of iron with sulphate of quinine is 
generally preferred. 1} Quininae sulphat., 3 ij ; ferri sulphat. exsic, 
3 ss. M. Ft. pil. no. xxx. Sig. : One pill three times a day, or 
four or five during the day. 

Although the preparations of iron are of little service in leucocy- 
thozmia, they are certainly in a high degree useful in pseudo-leucocy- 
thwmia, or cachexia of the spleen. In the latter disease the relative 
number of blood-corpuscles may be greatly reduced, but they can be 
increased in number and raised to the normal by the use of those 
materials needed by the blood-making organs, especially by the use 
of iron. 

In syphilitic cachexia, the preparations of the iodide of iron possess 
a high degree of utility. In sloughing phagedena, or simple chancroid, 
the iodide is frequently prescribed when these accidents occur in debili- 
tated constitutions. Some authorities prefer the tartrate of iron under 
these circumstances, but the iodide acts with more promptness and 



140 RESTORATIVE AGENTS. 

vigor. In the treatment of constitutional syphilis, the ferruginous prep- 
arations are only useful in so far as they may be applied to promote 
constructive metamorphosis. More commonly than is supposed by the 
advocates of special plans of treatment, tonic remedies, esj^ecially cha- 
lybeates, exercise a most favorable influence over the course and dura- 
tion of syphilis, fy Iodoformi, 3 j ; hydrargyri chloridi corrosiv., gr. 
j ; ferri redacti, 3j. M. Ft. pil. no. xx. Sig. : One pill three times 
a day. $ Iodoformi, chinoidin., ferri redacti, aa 3j. M. Ft. pil. no. 
xx. Sig. : One pill three times a day. 

Iron is one of the remedies most useful in the treatment of acute 
rheumatism. As was originally suggested by Reynolds, the tincture 
of the chloride is most serviceable. It is more especially adapted to 
the treatment of pale, delicate, and cachectic subjects, and is much 
less beneficial, if not positively harmful, in the plethoric and overfed. 
Given in suitable cases, the tincture of iron, in doses of tii, xx — xxx 
every four hours, diminishes the pain, fever, and sweats, lessens the 
chances of cardiac mischief, and hastens convalescence. By retarding 
waste and favoring excretion of uric acid through the kidneys, the 
duration of the disease is shortened and a tedious convalescence is pre- 
vented. We owe to Dr. Anstie the important suggestion that tinc- 
ture of chloride of iron may be used successfully as a prophylactic 
against acute rheumatism. Here, again, the author must state, as a 
result of his personal observation, that such prophylactic treatment is 
very useful in weak and cachectic subjects and not applicable to the 
robust and full-blooded. The tincture of iron should be administered 
without delay in such weak subjects with a rheumatic history, w T hen 
they complain of lassitude, muscular pains, sore joints, furred tongue, 
although they are yet free from fever and joint-swellings. 

The treatment of erysipelas by large doses (in, x — 3 j every four 
hours) of tincture of chloride of iron is now very generally adopted. 
It is questionable whether this practice is directly beneficial. Its utility 
depends chiefly on the support which it affords to the organism while 
laboring under a debilitating disease, and, as an abundant supply of 
aliment is prescribed with the iron, it is impossible to estimate in any 
given case how far the result may be attributable to the remedy. 

Influenced by the same considerations, the tincture of iron is fre- 
quently prescribed in diphtheria, alone or in combination with chlorate 
of potassa. Although it possesses no special utility in this disease, it 
may serve as one of the means for maintaining the forces of the body, 
and in this way indirectly contribute to a favorable result. There is 
no advantage in applying the tincture of iron to the fauces in diph- 
theria ; it is not a solvent of the false membrane, and can not prevent 
the spread of the exudation ; it is, however, now freely used, and it is 
said with good results. 

In the treatment of scrofula, strumous enlargement of the cervical, 



IRON. 141 

inguinal, and mesenteric glands, and in rickets, the preparations of iron 
occupy a most important place. In these affections the sirup of the 
iodide of iron is generally preferred, and excellent results are obtained 
from a combination of phosphate of iron and phosphate of lime, espe- 
cially in rickets. In these cases, also, the sirup of the iodides of iron 
and manganese is indicated. Iron is one of the remedies most fre- 
quently prescribed in chronic tuberculosis, but it has no special influ- 
ence over the deposition of tubercle. It helps to a better state of the 
blood-making process, and, by promoting the constructive metamor- 
phosis, hinders the progress of the malady. 

As neuralgia so often depends on anaemia, it happens that iron is 
one of the most frequently prescribed remedies for this disease. Anstie 
prefers large doses (ttj, xxx — xl ter die) of the tincture of the chloride, 
and twenty-grain doses of the saccharated carbonate twice or three 
times a day. 

In disorders of the mind, either dependent on or increased by an 
anaemic state, iron is often useful. In chronic mania and melancholia, 
when debility is present, iron is employed as a restorative agent. The 
ferruginous preparations are especially useful in the ancemic forms of 
puerperal mania, and in the insanity of lactation. Bucknill and Tuke 
prefer the tincture of the chloride in these affections. 

Iron has been much used in the epilepsy of weak and anaemic sub- 
jects, but it seems to the author to be more hurtful than beneficial, as 
a rule, yet he has seen excellent results from a combination of bromide 
of iron and bromide of potassium in such cases : I> Potassii bromidi, 
| j ; ferri bromidi, gr. iv ; aquae, J ij ; syrup, simplicis, % vj. M. 
Sig. : A tablespoonful bis die. 

Large doses of subcarbonate of iron have long been used with ad- 
vantage in chorea. When the subject of this disease is distinctly 
anaemic, iron, in some of its forms, is unquestionably serviceable, and 
its utility is often increased by combination with purgatives. When 
anaemia is not present, arsenic is preferable to iron. Chorea arising 
from moral causes (anger, fright, etc.), and from pregnancy, is not 
benefited by iron. This remedy is especially adapted to the chorea of 
anaemic girls about the age of puberty. 

The preparations of iron are of course inadmissible in acute affec- 
tions of the respiratory organs, but, in certain of the chronic forms 
and stages of these diseases, some of the chalybeates are very useful. 
In chronic bronchitis, with free expectoration, the mistura ferri com- 
posita has long been used with advantage. At the present time the 
phosphate of iron, quinine, and strychnine, is generally preferred in 
chronic bronchitis, in the chronic forms of phthisis, in emphysema, 
and in humid asthma. Iron is contraindicated when pulmonary 
haemorrhage exists or is threatened. A combination of tincture of 
digitalis and tincture of chloride of iron abates the temperature and 



142 RESTORATIVE AGENTS. 

diminishes the sweats of hectic fever, fy Tinct. digitalis, 3 iij ; 
tinet. ferri chloridi, 3 v. M. Sig. : Fifteen drops three or four 
times a day. 

In fatty degeneration of the heart, the preparations of iron render 
important service, by improving the nutrition of the organ. The pal- 
pitations, the murmur, and prcecordial anxiety which accompany cases 
of anaemia and chlorosis, are relieved by chalybeate medicines. In 
dilatation of the cavities of the heart, especially the right, accompanied 
by cough, difficult breathing, and general dropsy, greater relief is some- 
times experienced from the preparations of iron than by the so-called 
cardiac sedatives and diuretics. In these cases, as also in mitral regurgi- 
tation, the distress of the patient increases with increasing thinness of 
the blood, and is diminished by those remedies, such as iron, which 
improve the quality of the blood. A combination of iron, digitalis, and 
squill, is sometimes extremely serviceable in these cases — for example : 
~fy Ferri redacti, quininae sulphat., pulv. digitalis (English), aa 3 j ; pulv. 
scillae, gr. x. M. Ft. pil. no. xx. Sig. : One pill three or four times a 
day. Iron may be used with advantage to assist in the process of 
compensation in valvular lesions, when the condition is one of anaemia. 
Iron is contraindicated in all cases of cardiac disease occurring in those 
who are full-blooded. 

In the passive forms of haemorrhage — in purpura, the hcemorrhagic 
diathesis, epistaxis, gastric, intestinal, and renal haemorrhage, when 
they are due to anaemia or favored by it — iron is unquestionably use- 
ful, and the preparation most generally applicable is the tincture of 
the chloride. 

Derangements of the menstrual function, when associated with 
anaemia, more especially when produced by anaemia, are often removed 
by the use of chalybeate medicines. Amenorrhcea is, more frequently 
than to any other cause, due to anaemia of the ovaries, consecutive to 
chlorosis or general anaemia, and dysmenorrhcea may depend, in one of 
its forms at least, upon the same condition of the blood. Menorrhagia 
may also be one of the results of an impoverished state of the blood. 
Iron is the most appropriate medicament in these disorders. It is the 
judgment of Graily Hewitt and Barnes that " small doses of iron are 
generally the best " in amenorrhcea. Barnes prefers the solution of the 
acetate, and speaks favorably of the citrate of iron and ammonia, given 
in an effervescent state, and of the combination of iron and strychnine. 
The use of ferruginous preparations in menstrual disorders should be 
determined by the results of a careful differentiation of the causes. 
The absence of the uterus and ovaries, occlusion of the cervix, and 
various other conditions besides anaemia, should be eliminated, and the 
use of iron restricted to those cases in which an impoverished state of 
the blood is either the only factor or an influential one. 

The injection of the various styptic solutions of iron into the 



IRON. 143 

uterine cavity, to arrest post-partum hemorrhage, is now common 
practice. Notwithstanding the alleged innocuousness of this treat- 
ment, it is probable, as Snow Beck has shown, that fatal results have 
ensued from the incautious use of these injections. The official solu- 
tions of the perchloride and subsulphate have been thrown into the 
uterine cavity, with the effect to cause uterine thrombosis, followed 
by systemic infection. These solutions are much too strong ; one part 
of Monsel's solution to three of water is sufficiently styptic, and is 
probably perfectly safe. The uterine cavity should be cleared of clots, 
and the nozzle of the syringe carried well up to the fundus, when the 
injection should be slowly delivered. The reader need hardly be re- 
minded that this expedient is only proper after the usual means for 
securing uterine contractions have failed. The same plan of styptic 
injections has been used to arrest the hemorrhage from abortion, but 
caution is necessary in these cases, for it is essential to safety that 
there be an open and patulous condition of the os, to permit escape of 
coagula. Similarly these injections are used to restrain bleeding in 
cases of uterine fibroids, uterine cancer, and in the uterine hemorrhage 
dependent on spongy granulation of the mucous membrane. In every 
case of such use of styptic iron injections, it is essential, first, that air 
be not pumped into the uterine cavity, and second, that sufficient dila- 
tation of the cervical canal exist to permit ready exit to the surplus 
fluid and coagula. 

In albuminuria, connected with chronic changes of the kidney, iron 
is often very serviceable to improve the digestion, and to correct the 
anaemia, which is such an obvious feature of these maladies. The 
tincture of the chloride and the tincture of the acetate — especially the 
latter — are preferred, partly on account of their value as hsematinic 
remedies, and partly because of their supposed diuretic action. When 
spermatorrhoea is dependent upon an impoverished condition of the 
blood, with relaxation of the vesiculse seminales, the tincture of iron 
is useful, but it is rarely of itself sufficient to effect a cure. The chalyb- 
eates are only harmful in those cases of nocturnal seminal losses which 
in the robust are merely significant of plethora. In gleet occurring in 
anaemic subjects, and in the prostorrhoea and catarrh of the urethra 
which arise from relaxation, the preparations of iron are useful 
adjuncts to other measures. ^ Tinct. ferri chloridi, 3 vj ; tinct. 
cantharidis, 3 ij. M. Sig. : Fifteen drops in water, three times a 
day. 

The sirup of iodide of iron is one of the most successful remedies 
in the nocturnal incontinence of urine in children. The precise indi- 
cations for its use are not evident. Sometimes belladonna succeeds 
better. It appears to the author that the iodide of iron is more useful 
in the case of pale, delicate, and strumous children, and belladonna in 
those who are more robust, the condition in the former being one of 



144: RESTORATIVE AGENTS. 

atony of the muscular wall of the bladder, in the other too ready con- 
traction from the reflex stimulation of acid urine. In these cases of 
incontinence of urine the sirup of the iodide should be given in doses 
of fifteen to twenty minims, well diluted with water, three times 
a day. 

Local Uses. — The styptic preparations of iron are frequently used 
to restrain haemorrhage. Leech-bites that bleed too profusely, haemor- 
rhage after extraction of teeth or in minor surgical operations, oozing 
from a large wounded surface, may often be checked by the use of 
Monsel's solution. 

As a topical application in gonorrhoea after the acute symptoms 
have subsided, in mucous cervicitis, in leucorrhoea, the styptic prepa- 
rations of iron are certainly useful, but a strong objection to their use 
arises from the staining of the clothing. 

Monsel's solution is an effective application to fissured nipples : r> 
Liquor ferri subsulphatis, 3 ij ; glycerini, 3 vj. M. Sig. : Apply with 
a camel's-hair brush to affected parts. Pure solution of subsulphate of 
iron will arrest the growth and cause the exfoliation of syphilitic vege- 
tations of the glans and prepuce. 

Authorities referred to : 

Anstie, Dr. Francis E. Neuralgia and its Counterfeits, Macmillan & Co., London, 
1871, p. 181. 

Barker, Dr. Fordyce. Puerperal Diseases, New York, 1874, p. 183. 

Barnes, Dr. Robert. A Clinical History' of Diseases of Women, London, 1873, p. 185. 

Bucknill and Tuke. Manual of Psychological Medicine, third edition, London, 1874, 
p. 764. 

Christison, Dr. Robert. A Treatise on Poisons, Edinburgh, 1832, p. 573. 

Eulenburg, Dr. Albert. Lelirbucli der functionellen Nervenkrankheiten, Berlin, 1S71, 
pp. 71, 198, 448, etc. 

Gubler, Dr. A. Commentaires TJierapeutiques du Codex Medicamentarius, Paris, 1868. 

Hewitt, Dr. Grailt. Diseases of Women, second edition, London, 1868, p. 413. 

Jahresbericht uber die Fortschritte der Pharmacognosie, Pharmacie und Toxicologic, 
Gottingen, 1872, p. 237, art. Eisen. 

Poidem, 1872, p. 523, Eisengehalt verschiedener vegetabilischer und thierischer Sub- 
stanzen. 

Lussana, Prof, von Ph. Lo Sperimentale, October, 1872, Schmidt's Jahrbucher der 
gesammten Medicin, vol. elvi, p. 262. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 411, et seq. 

Pokrowsky, Dr. "W. Vir chow's Archiv, vol. xxii. 

Squire, Peter. Companion to the British Pharmacopoeia, eighth edition, London, 1871. 

Taylor, Dr. A. S. On Poisons, third English edition, 1875, p. 4S4. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere Medicate, huitieme 
edition, art. Fer. 

United States Dispensatory, thirteenth edition. 

"Waldenburg und Simon. Handbuch der allgemeinen und speciellen Arzneiverordnungs* 
Lehre, achte Auflage, 1873. 

Woronichin, Dr. N. Wien. med. Jahrbuch, xv, Schmidt's Jahrbucher der gesammten 
Medicin, vol. cxxxviii, p. 288. 



MANGANUM. 145 

MANGANUM. 

Manganese. — Mangan, Ger. ; manganese, Fr. 

Mangani Oxidum Nigrum. — Black oxide of manganese. Dose, 
gr. ij — gr. x. In pill or powder. 

Mangani Sulphas. — Sulphate of manganese. In colorless or pale 
rose-colored transparent crystals, freely soluble in water. Dose, gr. 

ij— gr- v. 

Unofficial preparations : 

Syrupus Ferri et Mangani Ioclidi. — A pale straw-colored sirup. 
Dose, tt[ x — 3 ss. 

Ferri et Mangani Carbonas Sacch. — A tasteless, reddish-brown 
powder. Dose, gr. v — 3j. 

Syrupus Mangani Iodidi. — A sirup which corresponds in strength 
to the official sirup of the iodide of iron, and may be given in corre- 
sponding doses. 

Besides the above, a carbonate, phosphate, tartrate, malate, and lac- 
tate have been proposed for use, but hitherto they have not attracted 
attention and are rarely employed. The official and unofficial prepa- 
rations named above are all that, according to the present state of pro- 
fessional experience on the subject, will ever be required. It will be 
most convenient, however, to include with the manganic preparations 
the following : 

Fotassii Fermanganas. — Permanganate of potassa. In needle- 
shaped crystals of a deep purple color. It is soluble in sixteen parts 
of cold water, and the solution has a deep purple to a rose-color, ac- 
cording to the state of dilution of the salt. Dose, gr. ss — gr. ij. In 
prescribing the permanganate, freshly distilled or boiled and filtered 
river-water, to free it from organic matter, should be directed. 

Physiological Actions. — The sulphate has an extremely disagree- 
able styptic and metallic taste ; the black oxide less so, and the saccha- 
rated carbonate is free from any taste except that of the sugar. The 
preparations of manganese are somewhat irritant to the gastrointesti- 
nal mucous membrane, and the sulphate is emeto-cathartic in full doses. 
There seems to be no doubt that the sulphate has a decided cholagogue 
effect, for very large discharge of bile is a result of its cathartic action. 
In small doses the manganic salts promote the appetite and digestive 
function. They probably enter the blood as albuminates. The inti- 
mate association of manganese with iron throughout the economy of 
Nature is exemplified in the human body. They are found together 
in the blood, hair, bile, biliary concretions, and renal calculi. The pro- 
portion of manganese to iron in the red blood-corpuscles is as one to 
twenty. As an essential constituent of the blood, it undoubtedly has 
to do with the constructive metamorphosis of the body. Used in large 
doses and for a considerable period of time, it produces effects analogous 
to those of zinc — progressive wasting and feebleness, a staggering gait 
11 



146 RESTORATIVE AGENTS. 

and paralysis (paraplegia). In toxic doses, according to the researches 
of Laschkewitsch, it causes in animals death by convulsions. In smaller 
doses it diminishes the pulse-rate, lowers the action of the heart, and 
lessens the blood-pressure. Like phosphorus, manganese induces acute 
fatty degeneration of the liver. When it is injected into the veins of 
animals, it causes tetanic cramp, dilatation of the pupil, exophthalmus, 
and death ; and after death the heart-muscle does not respond to elec- 
trical stimulation (Laschkewitsch). 

Antagonists. — The preparations of manganese are not incompat- 
ible with the vegetable astringents. The salts of lead, silver, and 
mercury, and the caustic alkalies, are chemically incompatible with 
manganese. 

Synergists. — Iron is synergistic as regards haBmatinic effects, and 
the salts of copper, silver, and zinc, as regards the effects on the nerv- 
ous system. 

Therapy. — Although manganese has not of itself been very useful 
in the treatment of anaemia and chlorosis, yet there is no doubt that its 
combination with iron much increases the efficacy of the latter. Some 
of the preparations named at the head of this article, especially the sac- 
charated carbonate of manganese and iron, may be usefully prescribed in 
these diseases. Cachectic states arising from syphilis, cancer, struma, 
gout, prolonged suppuration, chronic malarial infection, etc., are ad- 
vantageously treated by the sirup of the iodide of iron and manganese. 

Gastrodynia and pyrosis, according to Dr. Leared, are relieved by 
ten to fifteen grain doses of the black oxide — not the commercial article, 
but the oxide purified by washing with hydrochloric acid. In these 
disorders the effects of manganese are similar to those of bismuth 
(nitrate and carbonate), of zinc, and silver (oxide). Small doses of 
manganese (sulphate) may be usefully combined with iron and quinine 
when prescribed to promote constructive metamorphosis. I> Quinince 
sulph., ferri sulph. exsic, mangani sulph. exsic, aa 3 j. M. Ft. pil. no. 
xx. Sig. : One to three pills three times a day. In jaundice of mala- 
rial origin, or from catarrh of the biliary passages, the author has seen 
excellent results from the use of manganese. R Cinchonidinse salicy- 
late 3 ij ; mangani sulph. exsic, 3 ij. M. Ft. pil. no. xx. Sig. : Two 
pills three times a day. I£ Fel. bovin. purif., 3 j ; mangani sulph. 
exsic, 3 ij ; resinae podophylli, gr. v. M. Ft. pil. no. xx. Sig. : 
One three times a day in catarrhal jaundice. In the elisor dered di- 
gestion of gouty subjects, and to restore the activity of the assimilative 
functions after attacks of gout, manganese is most serviceable, espe- 
cially as combined with salicylates. 

Manganese (chloride) has been used by Osborne with success in 
hemorrhage (epistaxis), and the sulphate is one of the remedies for 
chronic rheumatism, neuralgia, cholera, and syphilis. 

An ointment of the oxide ( 3 ij — 3 j adeps suil.) has been used with 



MANGANUM. 147 

advantage in tinea, scabies, and other chronic skin-diseases. ^ Man- 
gani oxid., sulphuris, saponis dur., aa § j ; adipis suilli, 1 iij. M. Oint- 
ment for porrigo. 

Actions and Uses of the Permanganate of Potassa. — This salt is a 
very powerful oxidizing agent, and yields up its oxygen readily in the 
form of ozone. Its use as an internal and external remedy is based on 
this chemical fact. That it parts with its oxygen so readily is held by 
some to demonstrate its entire inutility when administered by the 
stomach. Although it must instantly be decomposed on reaching the 
stomach, there are satisfactory reasons for believing that it exerts a 
favorable influence on certain diseases in which, theoretically consid- 
ered, it may be indicated. The author has seen marked advantage 
from its use in the dyspepsia and flatulence so constantly attendant on 
obesity. It has also appeared to be very serviceable as a remedy for 
an abnormal and excessive deposition of fat. In the so-called uric-acid 
diathesis it favors the conversion of uric acid into urea, and thus pre- 
vents the formation of uric-acid calculi. Pain in the lumbar region, 
frequent micturition, acid urine, much brick-diist sediment, and intes- 
tinal indigestion, are associated symptoms relieved by the perman- 
ganate. Under the same conditions, it is probable acute rheumatism 
is developed, and to the action of the permanganate as an oxidizing 
agent is attributable the benefit which is sometimes obtained from its 
use in this disease. In scarlatina and diphtheria the permanganate is 
used with undoubted benefit, applied to the throat and taken by the 
stomach. In erysipelas, puerperal fever, septicaemia, it has been given 
with advantage. Lately it has been used with success as a remedy 
for the bites of venomous snakes and other animal poisons, applied 
locally and given internally (Lacerda). Drs. Ringer and Murrell have 
found it an effective remedy in the treatment of amenorrhoea, one or two 
grains being given in pill form three times a day. Since the publication 
of this discovery, many cases confirming its truth have been reported 
from all quarters. Recently it has been affirmed that the salts of man- 
ganese possess this property in common, and that it is not a special en- 
dowment of permanganate. The author can not but regard this as 
doubtful, since he has not obtained the same results from the other man- 
ganese preparations, although recognizing the desirability of having 
less irritating agents for the purpose. The dose of three to five grains 
recommended by Drs. Ringer and Murrell can be taken by few patients 
— if any — without experiencing very considerable gastric disturbance. 

The mode of administering permanganate in the condition of amen- 
orrhoea has much importance, since it is usually necessary to give the 
largest doses that can be taken without causing so much gastric dis- 
turbance as to compel its suspension. The best form in which to pre- 
scribe it is probably the compressed pellets containing one or two 
grains of the salt. A large draught of water that has been recently 



148 RESTORATIVE AGENTS. 

distilled, or, better, that has been boiled and filtered, should immedi- 
ately follow the pellet — for free dilution in the stomach will not only 
promote absorption, but will lessen the action on the mucous mem- 
brane. The rapidity with which the color of a permanganate solution 
Avill be discharged in common river-water has been much exagger- 
ated ; the author ascertained that, when added to a vessel of the Schuyl- 
kill water, no appreciable change took place in a half -hour. Further, 
when a solution made by dissolving a compressed pellet in ordinary 
river-water is put into urine, the color is not at once discharged, but 
an interval of several minutes elapses before the change is completed. 

That the large proportion of active oxygen present in the perman- 
ganate contributes to the therapeutical action can hardly be denied, 
and that it is an element in the action on the organs of menstruation 
must be admitted also. The author, therefore, advises the use of 
permanganate of potassium in amenorrhea, rather than the salts of 
manganese, although the latter may be used when the former can not 
be borne. The remedy should be administered during the week pre- 
ceding the time of the menstrual flow, and the dose given must be 
small, with the necessary frequency, so that about ten grains be received 
each day. When the other salts of manganese are substituted, such 
combinations as the following will be found useful : I£ Ferri sulph. 
exsic, mangani sulph. exsic, aa 3j ; ext. aloes, gr. iv ; ext. ignatiae 
vel nucis vomicae, gr. v. M. Ft. pil. no. xx. Sig. : One pill three 
times a day. The amount of manganese in this prescription can be 
trebled if need be. r> Ferri et mangani carb. sacch., 3 ij. Ft. pulv. 
xx. Sig. : One powder three times a day. This latter remedy is espe- 
cially commended because of its remedial value and of the ease with 
which it is administered, since it is almost tasteless. 

The value of permanganate of potassium in amenorrhcea having 
been confirmed by Lvaff (Russia), Yargunin was induced to try it in 
cases of dysmenorrhea characterized by scanty flow, and a general con- 
dition of anaemia. The result justified the a priori judgment, and 
equally fortunate cases have been reported by others since. It is a 
necessary condition for the successful use of permanganate in these 
affections that the state of the patient be that of depression, anaemia, 
or chlorosis, and that the organs concerned in the menstrual function 
be wanting in activity. Congestion or inflammation of the pelvic or- 
gans is a positive contraindication. 

It should not be forgotten that pills containing permanganate of 
potassium in some combinations are explosive. There is, however, no 
actual necessity for combinations of this kind. 

Among the important uses of permanganate of potassa are its ex- 
ternal applications as a disinfectant. It is a deodorizer as well as a 
disinfectant. It is very frequently used ( 3 j — Oj) to correct the fetor 
of cancer, idcers, caries, abscesses, etc. It is used as an injection, or in 



CHALYBEATE SPRINGS. 149 

the form of spray, to destroy the odor of the discharges and to alter 
the morbid action, in cases of ozwna, otorrhoea, etc. It is an elegant 
toilet preparation (gr. j — | j) for destroying the odor of a foul 
breath, the smell of the axilla, and the fetor of the sweat of the feet. 
See "Antiseptics " for further information. 
Authorities referred to : 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 195. 

Lacerda, Dr. Bui. Gen. de Therap., vols. ci. and civ. 

Laschkewitsch, W. Vcrgleichende Untersuchungen uber die WirJcung der Mangan- 
und Eisensalze. Medicinische Centralblatt, 1866, No. 24. 

Drs. Ringer and Murrell. The Practitioner, 1884. 

Trousseau et Pidoux. Trait'e de Therapeutique et de Maiiere Medicale, huitieme 
edition, Paris, 1868, vol. i, p. 59. 

CHALYBEATE MINERAL SPRINGS. 
1. Nokth Amebic an. 

Bailey Springs, Lauderdale County, Alabama. 

These springs contain carbonates of potassa, soda, magnesia, car- 
bonic-acid gas, oxide of iron, etc. 

Rawley Springs, Rockingham County, Virginia. 

Carbonate of iron (0*203 grain) is the most important ingredient in 
these waters. They contain, also, carbonates of manganese, magnesia, 
lime, and lithia, and sulphates, etc. 

Sweet Chalybeate Springs, Alleghany County, Virginia. 

The name of this water is derived from its sweetish taste. It is 
highly charged with carbonic-acid gas, and contains sesquioxide of 
iron, with sulphate of lime (4*110 grains), sulphates of magnesia and 
soda, and chlorides of lime, sodium, magnesium, etc. 

Rockbridge Alum Springs, Rockbridge County, Virginia. 

Bath Alum, Bath County, Virginia. 

These waters are remarkable for containing free sulphuric acid* 
They contain also sulphates of magnesia and lime, protoxide of iron, 
and carbonic- acid gas. The Bath Alum waters contain twice as much 
iron as the Rockbridge Alum. 

Bedford Alum Springs, Bedford County, Virginia. 

Similar in composition to the above, but contain a larger proportion 
of iron, and of the salts of potassa, magnesia, and lime. 

Bedford Springs, Bedford County, Pennsylvania. ^ 

This water contains carbonate of iron (0*625 grain) associated with 
a large proportion of sulphate of magnesia (10 grains), and is, there- 
fore, a laxative chalybeate. 

2. European. 

Bascombe, Bournemouth, Hampshire, England. 

Chalybeate springs containing carbonic acid in combination. 



150 RESTORATIVE AGENTS. 

Dortoil, Buckinghamshire, England. 

Contains sulphate of iron and is charged with carbonic acid. Re- 
quires dilution for drinking. 

Hastings, Sussex, England. 

Contains sulphates of iron, magnesia, lime, and soda. 

Sandrock, Isle of Wight. 

Is a strong aluminous chalybeate — 41^ grains of sulphate of iron, 
and 3H grains of sulphate of alumina in twenty ounces — and therefore 
requires dilution for drinking. 

Timbridge, Kent, England. Altitude, 289' ; temperature, 50° Fahr. 

This water contains one eighth of a grain of iron with carbonic 
acid, in twenty ounces. 

Spa, Belgium. Altitude, 1,030'. Season, August and September. 
Temperature of water, 52° Fahr. 

These waters contain carbonates of iron, manganese, soda, lime, and 
magnesia, etc., and are highly charged with carbonic acid. 

Pyrmont, Waldeck. Altitude, 404' ; mean annual temperature, 
48-5° Fahr. 

The quantity of carbonic-acid gas is unusually great in these waters. 
They contain sulphates of lime, soda, magnesia, and carbonates of iron, 
soda, magnesia, and lime. 

Alexisbad, near Harzgerode, Germany. 

Alexisbrunnen. Same. 

Both contain iron and manganese in large quantity, and also car- 
bonic-acid gas. The first named, being highly impregnated with chloride 
and sulphate of iron, is used for bathing, and the other for drinking. 

Schwalbach, Nassau. Altitude, 909'. Season, June to September. 
Temperature, 64° Fahr. 

According to the analysis of Fresenius, this valuable water contains 
bicarbonates of iron, manganese, soda, magnesia, and lime, sulphates of 
soda and potash, and chloride of sodium. It is very highly charged 
with carbonic acid. 

St. Moritz, Upper Engadin, Switzerland. Altitude, 5,464'. Mean 
temperature of summer months, 51° Fahr. 

These springs contain from ten to fourteen grains of solids in a 
pint, consisting of carbonates of lime, magnesia, manganese, iron, and 
soda, etc., and as much as 39*5 cubic inches of carbonic acid. 

Therapy of Chalybeate Waters. — The uses of these waters are 
the same as the purely medicinal preparations of iron. They are in- 
dicated in chlorosis and anaemia, to supply to the blood the material 
in which it is deficient. For this purpose the milder waters, contain- 
ing carbonate of iron and abundant carbonic acid, are most suitable ;. 
for example, in this country, Bedford (Pennsylvania) — Columbian 
Spring, Saratoga, and the "Sweet," of Virginia, etc.; in England, 
Bascombe and Tunbridge ; on the Continent, Pyrmont, Spa, Schwal- 
bach, St. Moritz. yfhen passive haemorrhages — the haemorrhagic di- 



BISMUTH. 



151 



athesis— require ferruginous waters, the alum and iron waters are more 
effective. Amenorrhea, hysteria, and other pelvic disorders, when 
dependent on anosmia, the paludal cachexia, leucocythemic-exophthalmic 
goitre, are either cured or decidedly ameliorated by chalybeate waters. 

The purgative iron waters are useful in engorgement of the liver, 
haemorrhoids, and dyspepsia of ancemic subjects, in albuminuria and 
dropsy ; the alum springs in chronic diarrhoea and strumous diseases. 

Neuralgia, chorea, cerebral anazmia, and other nervous disorders 
due to an impoverished condition of the blood, are much improved by 
the use of the milder chalybeate waters. 

In making selection of a chalybeate water the psychical influences 
of mountain scenery, or other pleasant surroundings, should not be dis- 
regarded. For the anaemic pulmonary invalid, elevation of the spring 
and the absence of humidity are important considerations to determine 
a selection. Hence, the present popularity of St. Moritz. In this coun- 
try a great variety is afforded — mountain scenery like Bedford, Penn- 
sylvania, and the Virginia springs, or rolling upland like Bailey's and 
Sharon. As respects composition, the ferruginous springs of the United 
States are equal to any in the world. 

For authorities referred to, see articles on Alkaline and Saline 
Springs. 

The remedies promoting constructive metamorphosis previously 
considered are constituent elements of the human body. Those now 
to be discussed act indirectly, by stimulating the organs concerned in 
blood-making. 



BISMUTHUM. 

Bismuth. — Bismuthi Subcarbonas. — Subcarbonate of bismuth. A 
white or yellowish-white powder, without taste or smell, insoluble in 
water. Dose, gr. x — 3 j, in powder or emulsion. 

. Bismuthi Subnitras. — Subnitrate of bismuth. A heavy, white pow- 
der, with a faintly acid odor and taste, insoluble in water. Dose, gr. 
x — 3 j, in powder or emulsion. 

Bismuthi Citras. — Citrate of bismuth. " A white, amorphous pow- 
der, odorless and tasteless, insoluble in water or alcohol." Dose, gr. 
v-3j. 

Bismuthi et Ammonii Citras. — Citrate of bismuth and ammonia. 
Small translucent scales, soluble in water. Dose, gr. v — gr. xv. 

Bismuthi Salicylas. — Salicylate of bismuth. Unofficial. Now much 
employed topically as an antiseptic dressing. The doses of five to fifteen 
grains can be used, as are the other salts of bismuth, internally, but it 
is more effective in catarrhal diseases of the gastro-intestinal canal. 

The solutions of bismuth do not produce the effects of the msolu- 



152 RESTORATIVE AGENTS. 

ble subcarbonate and subnitrate, and the various trade preparations 
containing bismuth and pepsin, bismuth and strychnine, bismuth and 
calisaya, etc., are, to the last degree, unscientific and unreliable. 

Physiological Actions. — The insoluble preparations have a very 
slightly metallic taste. They coat the tongue black by the formation 
of a sulphide. Given in suitable cases, they promote the appetite and 
increase the digestive power, and a gain in body-weight is one result 
of their administration. They are somewhat astringent, and retard the 
intestinal movements. As they are nearly insoluble, they pass down 
the intestinal tract and are converted into sulphides ; hence the faeces 
under their use become a dark slate color. They are not entirely in- 
soluble, for bismuth can be detected in the blood, urine, and other 
secretions, after a course of these medicines. Sufficient is absorbed 
under some circum stances, it is said, especially after prolonged admin- 
istration, to cause toxic symptoms ; but such a result must be due to 
accidental combinations, or to the presence of arsenic, which is a very 
constant impurity in the ordinary commercial preparations of subni- 
trate and subcarbonate of bismuth. Trousseau and Pidoux remark, 
with regard to its presumed toxic effect, as follows : " When the sub- 
nitrate of bismuth has been prepared from the perfectly pure metal, 
precipitated and well washed, it may be given in single doses from 
one to four grammes (fifteen grains to a drachm) without producing 
the least malaise" According to the same authority, Dr. Monneret 
has often given as much as ten to sixty grammes a day, without any 
recognized ill effects. It may therefore be concluded that the action 
of bismuth is chiefly local. The elaborate investigation of Steinfeld, 
made on animals, does not affect the question as just stated. His 
results were obtained by injecting solutions into the blood, and thus 
new elements enter into the problem, not of a character to be consid- 
ered as pertaining to the stomachal administration of insoluble salts. 

Therapy. — In the aphthm of children, nursing sore mouth, the 
milder cases of mercurial salivation, and in those painful ulcers of 
the mucous membrane of the mouth due to disorders of digestion, bis- 
muth applied freely to the affected parts is often very serviceable, by 
diminishing the pain and promoting the healing process. Bismuth 
allays the irritability of the mucous membrane in cases of acute indi- 
gestion, if given after the contents of the stomach are fully evacuated. 
It is especially indicated when there is not only painful digestion, but 
a tendency to diarrhoea, the inclination for stool coming on soon after 
the food has been taken. It is given with great advantage in subacute 
and chronic gastritis, and in gastrcdgia arising from a state of irrita- 
tion of the gastric mucous membrane. It is contraindicated, and is 
not beneficial, in the gastralgia produced by habitual constipation and 
in the gastralgia of chlorosis and hypochondria. The pain and vomit- 
ing attendant on gastric ulcer and scirrhus of the stomach are relieved 



BISMUTH. 153 

by bismuth, and in the case of the former disease this remedy con- 
tributes to the cure. In these painful affections, the good effects of 
the bismuth are enhanced by combination with morphine. ^ Bismuthi 
subnitrat., 3 ij ; morphine sulphat., gr. j. M. Ft. pulv. no. vj. Sig. : 
One three times a day in milk. When morphine is, from any cause, in- 
admissible, hydrocyanic acid may be given in a mixture with bismuth. 
I£ Bismuthi subnitrat., 3 ij ; acid, hydrocyan. dil., 3 ss ; mucilag. acacias, 
aquae menthae pip., aa § ij. M. Sig. : A tablespoonful three times a 
day. Although arsenic as an impurity is so objectionable that special 
pains are taken in the pharmaceutical process to separate it in the 
preparation of subnitrate, yet the author has witnessed excellent re- 
sults from a combination of arsenic and bismuth in the more chronic 
stomach-disorders for which the latter is prescribed. 

When bismuth is not well borne by the stomach, it may be com- 
bined with aromatic powder, or, when alkalies are indicated, it may 
be given with chalk or magnesia. When constipation is produced by 
it, bismuth can be administered with rhubarb or magnesia. 

Bismuth is one of the remedies most frequently employed in the 
treatment of the vomiting of teething children, cholera infantum, and 
summer diarrhoea. Numerous combinations are employed : with pep- 
sin, when these disorders appear to depend on the condition known as 
apepsia, the discharges containing masses of undigested casein ; with 
rhubarb, when the symptoms are produced by undigested aliment, or 
when the stools are white and pasty ; with soda and chalk, when the 
stools are acid and excoriate the buttocks. In cases of vomiting of 
pregnancy, the vomiting of teething children, acidity, and pyrosis, ex- 
cellent results are sometimes obtained from bismuth and carbolic acid, 
r) Bismuthi subnitrat., 3 ii ; acid, carbol., gr. ij — gr. iv ; mucil. acaciae, 
5 j ; aquae menthae pip., J iij. M. Sig. : A tablespoonful for adults 
and a proportionate quantity for children three or four times a day. 

The diarrhoea of typhoid fever is restrained by bismuth in scruple 
to half -drachm doses. In chronic diarrhoea large doses of bismuth 
are beneficial and often curative, but thirty to sixty grains must be 
given every three or four hours. Equally large doses check the diar- 
rhoea of phthisis. The salicylate of bismuth has been much used of 
late in these maladies, and its action, especially in typhoid, has been 
much commended. 

Bismuth is employed for a variety of purposes in the treatment of 
external maladies. It is a good application to the reddened surface of 
the skin in cases of acne rosacea, and may be used as a cosmetic in 
this mortifying disease. The author has seen excellent results from 
the free application of bismuth in cases of eczema when there was 
much serous exudation. Under the crusts thus formed healing pro- 
ceeded satisfactorily. In intertrigo and in the erythema which occurs 
about the genitals of infants, dusting the affected surface with bis- 



154 RESTORATIVE AGENTS. 

math soothes the pain and promotes healing. Bismuth is one of the 
numerous applications to the eye in cases of chronic conjunctivitis and 
granular lids. It is also used as an injection, mixed with mucilage, or 
with cocoa-butter in the form of a suppository, in chronic gonorrhoea 
and in gleet, and in leucorrhcea. IJ Bismuthi subnitrat., gr. vj ; 
hydrarg. chlor. cor., gr. ss ; tinct. camphorse, tti jss ; aquae ad § j. 
M, Lotion for skin diseases. 

The best vehicle for the administration of bismuth is milk. It should 
be given before meals as a rule when employed in stomach-disorders. 

Bismuth (subnitrate and salicylate) has become a very popular 
antiseptic dressing for wounds, ulcers, and epithelioma. Eltzina suc- 
ceeded in curing an unpromising case of noma by the application of 
bismuth and resorcin. Gosselin and Heret have employed it as an 
antiseptic dressing for wounds in general, and they advocate it for its 
influence over the process of suppuration, and its power to prevent 
septic decomposition. On the other hand, Dr. Delbastaille finds vari- 
ous objections to the use of bismuth for surgical dressing, although 
admitting its antiseptic power. The weight of evidence is in its 
favor, on the whole. 

Authorities referred to : 

Eltzina, Dr. Quoted in Vzrchow u. HirscWs Jahresbericht, 1885. 
Fox, Dr. Wilson. The Diseases of the Stomach, London, 18*72, pp. 93, 94, 139, 179, 
203, etc. 

Gosselin et Heret. Bull. Gen. de Therap., 1885. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 297, et seq. 

Steinfeld, Vladimir. Archiv fur exper. Pathol, u. Pharmacol., 1885, p. 40. 

ARSENICUM. 

Arsenic. — Acidum arseniosum ; arsenious acid. Acide arsenieux, 
Fr. ; Arsenige Saure, Ger. Dose, ^ — -^ grain. 

Arsenii Todidum. — Iodide of arsenic. Is an orange-red, crystal- 
line solid, entirely soluble in water, and wholly volatilized by heat. 
Dose, gr. <£>. 

Liquor Acidi Arseniosi. — Solution of arsenious acid. Dose, ni 
ij— v. 

Liquor Arsenii et Hydrargyri Lodidi. — Solution of iodide of ar- 
senic and mercury ; Donovan's solution. Dose, th, ij — v. 

Liquor Potassii Arsenitis. — Solution of arsenite of potassium ; 
Fowler's solution. (Arsenious acid, bicarbonate of potassium, com- 
pound spirit of lavender, and distilled water.) Dose, tti, ij — x. 

Liquor Sodii Arseniatis. — Solution of arseniate of sodium ; Pear- 
son's solution. Dose, ttx ij — xx. 

Arsenic in solution is better for internal administration than the 
solid arsenious acid, and, of the three solutions (official) mentioned 
above, Fowler's is the bes"t. Arsenious acid, when administered in 



ARSENIC. 155 

the solid form and at short intervals, may act with unexpected vio- 
lence. 

When a course of arsenic is begun, large doses should be pre- 
scribed, and the quantity administered should be regularly reduced. 
In this way chronic arsenical poisoning is avoided. When continually 
increasing doses are given, the arsenic accumulates, and toxic symp- 
toms are quickly induced. As a rule, unless very small doses are pre- 
scribed, arsenic should be taken after meals. Some subjects are soon 
seriously affected by even small doses of arsenic. For this reason, 
when the idiosyncrasies of the patient are unknown, it were better to 
make tentative experiments with a few small doses before beginning 
with large ones. A few drops of laudanum given with arsenic will 
enable it to be better borne by some susceptible subjects. 

Antagonists and Incompatibles. — The salts of iron, magnesia, 
and lime, and astringents, are chemically incompatible. The arseniate 
of iron, although not actively so, does cause toxic symptoms if con- 
tinued in full medicinal doses. The hydrated sesquioxide of iron, 
freshly precipitated, and in a soft magma, is the antidote to arsenic in 
solution. About eight grains of the antidote are required for each 
grain of the poison swallowed. As the hydrated sesquioxide of iron 
is harmless, it should be given in teaspoonful to tablespoonful doses, 
every few minutes. In every case of poisoning by arsenic, prompt 
efforts to secure evacuation of the contents of the stomach are neces- 
sary. Large doses of the antidote may be given with the emetic em- 
ployed. In the absence of the hydrated sesquioxide of iron, magnesia, 
chalk, and lime-water may be given freely. These agents act in part, 
and probably chiefly, mechanically, by enveloping the particles of ar- 
senic, and so hindering absorption. It is held by some that freshly 
precipitated hydrate of magnesia is more effective as an antidote than 
the hydrated sesquioxide of iron. Large draughts of oil, milk, and 
substances containing mucilage, by protecting the mucous membrane, 
render important service in cases of arsenical poisoning. Dialyzed 
iron, later experiences show, is quite as efficient as the hydrated sesqui- 
oxide, and is always ready. It is an important point to favor rapid 
elimination of the poison when the patient survives the acute symp- 
toms. This is accomplished by the use of diluent drinks, skimmed 
milk, slightly alkaline mineral waters, etc. 

Synergists. — All those agents which promote constructive meta- 
morphosis are synergistic to arsenic. 

Physiological Actions. — Applied to the tissues, arsenic excites 
violent inflammation and causes destruction of the part ; it is, there- 
fore, an escharotic. Great pain attends its action. In consequence of 
the high degree of inflammation which it excites, when applied in suf- 
ficient strength, absorption does not follow its local use, but weak ap- 
plications may excite dangerous symptoms by diffusion into the blood. 



156 RESTORATIVE AGENTS. 

Symptoms of poisoning follow the inhalation of arsenical fumes, 
Numerous instances have occurred in which wall-papers colored with 
arsenical pigments have poisoned the occupants of an apartment. Gar- 
ments covered with aniline dyes, fixed by arsenical mordants, have 
induced local ulcerations and systemic symptoms from absorption of 
arsenic. Applications to a large portion of even the unbroken integu- 
ment, and to ulcerated surfaces, have, in numerous instances, excited 
dangerous symptoms, and have produced fatal results. That arsenic, 
wherever applied, manifests a selective action on the mucous mem- 
brane of the respiratory and digestive tracts, is a curious fact. 

Arsenic, in small medicinal doses, promotes the appetite and diges- 
tive functions, and improves the body nutrition. It increases secretion 
of the gastro-intestinal mucous membrane, and hastens the peristaltic 
movements. Arsenic diffuses into the blood with facility. It probably 
enters into combination with the red blood-globules. It certainly 
lessens the excretion of carbonic acid, probably also of urea ; in other 
words, it checks the retrograde metamorphosis. It stimulates the 
cerebral functions and induces a feeling of well-being, and in some 
subjects decided mental exhilaration. 

In larger doses, yet not in quantity to produce acute poisoning, and 
when full medicinal doses have been administered for a lengthened 
period, arsenic causes more characteristic physiological actions than 
are described above. As regards the digestive organs, the following 
phenomena occur : A metallic taste ; increased flow of saliva ; nausea, 
vomiting of glairy mucus, epigastric pain, and soreness ; diarrhoea, 
tenesmus, and sometimes dysenteric stools. As regards the circulatory 
and respiratory organs : the action of the heart becomes irritable and 
feeble, palpitations, cough, oppressed breathing, oedema of the eyelids, 
general oedema, and albuminuria occur. As regards the skin : itching 
of the eyelids, urticaria, eczema, pityriasis, psoriasis, and falling out 
of the nails and hair. As regards the nervous system : disorders of 
motility — trembling, stiffness, and contraction of the joints, disorders 
of sensibility, herpes zoster. 

Notwithstanding the effects above described are so frequently ob- 
served to follow the use of arsenic, it is undoubtedly true that a cer- 
tain degree of tolerance may be established when doses in themselves 
toxic can be taken with impunity. This state has been produced in a 
course of the legitimate administration of arsenic, and has been wit- 
nessed on a considerable scale among the arsenic-eaters of Styria and 
Southern Austria. The arsenicophagi begin the habit of arsenic-eat- 
ing at an early age, and become habituated to the use of enormous 
doses. They find that this practice is serviceable in several respects : 
they improve in bodily condition, gain in breathing-power, and be- 
come stronger and more pugnacious, and also more salacious. 

When arsenic is swallowed in sufficient quantity to cause the symp- 



ARSENIC. 157 

toms of acute poisoning, the phenomena produced are of two kinds — 
gastro-intestinal irritation and cerebral effects. The former is much 
the more common. The following are the symptoms of the gastro-in- 
testinal form of acute arsenical poisoning : Burning at the epigastrium 
and radiating thence over the abdomen ; violent and uncontrollable 
vomiting ; great dryness of the mouth and fauces ; intense thirst ; 
intestinal irritation, bloody and offensive stools, retracted abdomen ; 
strangury, priapism, suppression of urine or bloody urine, and in fe- 
males menorrhagia ; rapid and feeble action of the heart, oppressed 
breathing ; great agitation and restlessness ; shrunken features, cold 
breath; involuntary evacuations; collapse — consciousness being re- 
tained to the last. In the cerebral form of acute poisoning, without 
any symptoms of gastro-intestinal irritation, the patient is suddenly 
put into a condition of profound insensibility and coma, not unlike 
extreme opium narcosis. 

Recovery from the effects of acute arsenical poisoning is rarely 
complete. For a long time afterward a considerable degree of gastro- 
enteric irritability will persist, and life may at last be lost from the 
continued operation of this pathological state on the function of nu- 
trition. An irritable state of the skin and stiffness of the joints may 
also continue for some time, and paralysis may supervene, accompa- 
nied with neuralgic pains, numbness, formication, etc. 

The changes found after death in the gastro-intestinal mucous 
membrane are those due to an irritant : deep redness, erosions, ecchy- 
moses, and softening. These alterations are also produced when toxic 
effects are caused by the external application of arsenic. More or less 
redness of the tracheal and bronchial mucous membrane and conges- 
tion of the lungs have been observed. It must not be forgotten that 
arsenic has caused a fatal result without producing any gastro-intesti- 
nal lesions except some uncharacteristic redness. Fatty degeneration 
of the liver, kidneys, spleen, and other organs, has been observed in 
cases of acute poisoning, even when the symptoms have existed for a 
few hours. The icterode hue of the skin and the albuminuria which 
occur in the course of chronic arsenical poisoning are probably due to 
fatty degeneration of the liver-cells and of the renal epithelium. 

Arsenic, although like other mineral poisons it tends to accumulate 
in the system, is nevertheless eliminated with considerable rapidity. 
If the patient survive a week after the ingestion of a toxic dose, it is 
difficult to detect it in the body after death. If the poison is retained 
and death ensues before elimination can take place, it undoubtedly re- 
tards putrefaction. Arsenic is eliminated by various organs — by the 
liver, intestinal canal, kidneys, and bronchial tubes — and some of the 
symptoms produced by it probably have their origin in the local effect 
of the poison on the channels of excretion. 

The quantity of arsenic required to produce a fatal effect varies ac- 



15S RESTORATIVE AGEXTS. 

cording to the state of the stomach and the susceptibilities of the pa- 
tient. Ounces have been swallowed without producing even serious 
symptoms, because promptly rejected by vomiting. When the stom- 
ach is full of food, absorption is slow and vomiting is easily induced, 
and hence a toxic dose may not under these circumstances produce 
any of the phenomena of poisoning. A half -grain of arsenious acid 
has caused symptoms of poisoning (Taylor), and, according to the 
same authority, from two to four grains may prove fatal to an adult. 
Much depends on the idiosyncrasies of the individual, which, as has 
been stated above, differ greatly in different persons. These facts 
should not be forgotten in prescribing strictly medicinal doses of ar- 
senical preparations. 

From this general survey of the effects of arsenic, we may properly 
proceed to study the results of more minute investigations. Yirchow 
has pointed out the similarity in the post-mortem appearances of arsenic 
and of cholera. The cholera-fungus of Klebs and the characteristic 
rice-water contents of the intestinal canal were not wanting to com- 
plete the resemblance. Hoffman has since fully confirmed these ob- 
servations. Croupous exudations are sometimes encountered in the 
stomach and intestines, and crystals of arsenic have been found im- 
bedded in the false membrane. This result is due to the action of 
arsenic when sw r allowed in powder, and is not produced when the 
poison is taken in solution (Filehne, Lesser). The gastro-intestinal in- 
flammation, present in a large proportion of cases, is due in part to the 
local action of the arsenic, in part to its selective action, but this fact 
does not justify the statements of Bohm and Unterberger that a larger 
dose of the poison is required to destroy life by the intravenous injec- 
tion than by the stomachal administration. Lesser holds with the 
authorities in general that arsenic, in common with other poisons, is 
more fatal by intravenous injection. In a small proportion of cases, 
as has been stated, gastro-intestinal inflammation does not occur, but 
the effects of the poison are expended on the nervous centers ; several 
hours after the ingestion of a large dose, delirium, followed by coma, 
and convulsions come on, and wdth these albuminuria, occasionally 
urinary suppression. The relation of the attacks of eclampsia to the 
albuminuria has not been settled. In still other cases the gastro-intes- 
tinal disturbance, the rice-water discharges, the collapse, simulate the 
algid stage of cholera. The remarkable fall in the blood-pressure of 
the abdominal vessels produced by arsenic certainly throws light on 
these phenomena (Bohm and Unterberger). 

The experiments of Sklarek have demonstrated that arsenic decid- 
edly impairs sensibility, leaving the motor functions untouched. In 
the human subject, however, as the result of acute poisoning, and 
sometimes after the acute symptoms have subsided, certain paralyses 
develop. They may be preceded by numbness and tingling, and may 



ARSENIC. 159 

be accompanied by contractures which disappear in curable cases, and 
remain permanently in incurable cases. The paralysis may be limited 
to a single member, and when several are thus affected the usual form 
of paralysis is paraplegia ; but all four members may be thus disabled. 
The rectum and bladder are not affected (Christison). These clinical 
observations by Christison are confirmed by the researches of Ringer 
and Murrell, who have shown that Sklarek's statements were incorrect, 
and that motor paralysis precedes sensory paralysis in the frog poi- 
soned by arsenic. {See Ponteland Poisoning Cases, "Lancet," Sep- 
tember, 1866.) 

The effects of arsenic on the circulation are not the same in cold 
and warm blooded animals, for, according to Sklarek, in the former 
the action of the heart is slowed, then arrested, while in the latter the 
action of the heart persists after the cessation of respiration (Bohm 
and Unterberger, Lesser). This fundamental difference in the action 
of arsenic on the two classes of animals requires us to accept with 
caution the observations made on the vaso-motor system of the cold- 
blooded. It has been pretty definitely ascertained that arsenic causes 
a fall in the blood-pressure, which is especially strong in the abdomi- 
nal blood-vessels (Bohm and Unterberger). 

A fact of great importance, first ascertained by Saikowsky, is the 
fatty degeneration of the liver, kidneys, heart, and other organs. The 
case of Grohl and Mosler, reported in the same volume of Virchow's 
" Archiv " containing Saikowsky's paper, is confirmatory more or less 
completely of the observations in the latter. They found, as their 
figures well exhibit, fatty degeneration to a greater or less extent in 
the glandular epithelium of the intestinal canal, and less conspicuous 
evidences of the same change in the kidneys, the liver, and the muscu- 
lar tissue of the heart. As the extent of the change is determined 
largely by the duration of the case, when death occurs in a few hours, 
or in a day or two, little alteration is discernible. 

The effect of arsenic on the function of nutrition is as yet involved 
in doubt. It is a recognized fact that arsenic promotes constructive 
metamorphosis when administered in medicinal doses. It has been 
ascertained by Saikowsky that it arrests the formation of glycogen by 
the liver, and C. Schmidt has shown that it lessens the excretion of 
carbonic acid and urea. Although doubt has been thrown on these 
statements, they seem to be supported by the observations of Lesser 
on the temperature, which has been constantly and considerably de- 
pressed under the action of lethal doses. The effect of arsenic in 
lowering the functional activity of the respiratory center is a fact 
which supports the same view, for a diminution in the quantity of oxy- 
gen admitted to the blood must necessarily lessen the rate of oxidation. 
On the other hand are the adverse experiments of Kassel, a medical 
student under Prof. Gathgens, and Gathgens himself, which appar- 



160 RESTORATIVE AGENTS. 

ently demonstrate an actual increase in the amount of urea excreted 
Arsenic has an anti-fermentative action ; but it is not universally 
destructive of the minute organisms on the presence of which the 
various fermentations are dependent. Thus it is poisonous to Torula 
eerevisicB and to some micrococci, but not to all, and it does not impair 
the activity of certain animal ferments, as pepsin, pancreatin, etc. 
(Johannsohn, Schafer, and Bohm). On the trophic system it acts as 
a depressant when taken in considerable quantity. The dust from 
arsenical wall-papers has induced a cachectic state, accompanied by 
headache, vertigo, and tinnitus (Donkin). Aniline dyes fixed by a 
mordant of arsenic have excited ulceration of the nails, phlegmon of 
the hands, and anaesthesia and paresis of the extremities (Clemans). 

Theeapy. — The preparations of arsenic are applicable to the treat- 
ment of the diseases of those tissues upon which it has a selective ac- 
tion. 

No remedy is more useful than arsenic in the so-called irritative 
dyspepsia, manifested by these symptoms : a red and pointed tongue, 
poor appetite, distress after meals, the presence of the food causing 
intestinal pain, colic, and the desire to go to stool. Drop-doses of 
Fowler's solution, given before meals, quickly relieve this state of 
things. The effects of the arsenic are frequently favored by the con- 
joint administration of a little laudanum. 

In some cases of the vomiting of pregnancy, a drop of Fowler's 
solution given before each meal will afford astonishing relief. The 
particular indications for its use are these : vomiting of food, followed 
by retching and straining, the vomited matters being streaked with 
blood, or blood alone being thrown up ; these symptoms accompanied 
by gastralgia and pain between the scapulae. 

The vomiting of chronic gastric catarrh, especially the alcoholic 
form, is relieved by one or two drops of Fowler's solution taken before 
meals. It effects a cure in these cases by relieving the morbid state 
of the mucous membrane on which the vomiting depends. Arsenic is 
also very beneficial in these small doses in chronic ulcer of the stomach. 
It checks the vomiting, relieves the pain, and improves the appetite 
for food. It is not equally effective in the acute ulcer. Although ar- 
senic exercises but little influence over the progress of these cases, it 
is very serviceable in cancer of the stomach, by diminishing the pain 
and checking the vomiting. Gastralgia and enteralgia, when idio- 
pathic, are sometimes made to disappear in a very surprising manner 
by the same remedy, but there are no certain indications of the kind 
of case to which it is best adapted. 

In the treatment of stomach-disorders, only small doses of arsenic 
are admissible. Large doses, by creating an irritation of the gastric 
mucous membrane, will only defeat the end in view. 

That form of diarrhoea which consists merely in an intolerance of 



ARSENIC. 161 

the presence of food, an evacuation of the undigested aliment taking 
place soon after it is swallowed, is cured by arsenic. Chronic diar- 
rhoea and dysentery (entero-colitis), especially when dependent on 
the changes induced by chronic malarial infection, are often greatly 
benefited by the same remedy. In these cases, two drops of Fowler's 
solution with five drops of laudanum should be given before meals. 
Attention to the diet is, of course, imperative. Constipation, when 
due to deficient secretion and dryness of the fseces, is sometimes over- 
come by small doses of Fowler's solution. 

Arsenic is one of the numerous remedies proposed for the treat- 
ment of epidemic cholera. It is a curious circumstance, first demon- 
strated by Yirchow, that some cases of acute arsenical poisoning are 
not distinguishable by their symptomatology or morbid anatomy from 
cases of epidemic cholera. 

Arsenic has been used with success in the treatment of the jaun- 
dice due to catarrh of the bile-ducts succeeding to catarrh of the 
duodenum. It seems to the author to be better adapted to cases of 
jaundice of malarial origin. Excellent results are obtained by the 
persevering use in small doses of arsenic in cirrhosis. As arsenic 
tends to accumulate in the liver, and as it produces fatty degeneration 
of this organ, the curative effect in the above-named disorders may 
depend on this selective action. 

There is no doubt that arsenic promotes in a very decided manner 
the constructive metamorphosis. It is one of the most valuable agents 
which we possess in the treatment of chlorosis and anmmia. It is es- 
pecially adapted to those cases in which iron does not agree or fails of 
effect. The efficiency of iron in these disorders is much increased by 
combination with arsenic. 

Cases of acute coryza and hay -asthma are often decidedly relieved 
by this remedy. Chronic catarrh of the broncho-pulmonary mucous 
membrane, emphysema, sclerosis of the lungs, are maladies in which 
arsenic, long used in ordinary medicinal doses, is capable of effecting 
considerable amelioration. We have no single drug of equal utility 
in the chronic forms of phthisis, but it is not serviceable in caseous 
pneumonia. It is said, and this statement corresponds to the author's 
observation, that, when there are much hectic and rapid disintegration 
of the pulmonary tissues, arsenic is not beneficial. Besides the stom- 
ach administration of arsenic in the above-mentioned maladies of the 
respiratory organs, it is used with advantage by the process of fumi- 
gation. The following is the formula of Trousseau for arsenical cigar- 
ettes : 

Arsenite of potassa 15 grains. 

Distilled water 1 ounce. 

Unsized white paper is thoroughly moistened with this solution, 
dried and cut into twenty equal parts, and each part rolled into a 



162 RESTORATIVE AGENTS. 

cigarette. Two or three of these are smoked daily for the relief of 
chronic bronchitis, emphysema, spasmodic asthma, phthisis, hay-asth- 
ma, etc. The arseniate of soda may be used in the same way, and 
under the same conditions ; for example, take a half -drachm to one 
drachm of arseniate of soda, one ounce of distilled water, and moisten 
a bit of unsized paper with the solution, so that every piece of a given 
size shall contain a determined quantity of the arsenic, ordinarily 
from one fourth to one grain. When the cigarette is lighted, the pa- 
tient inhales the smoke by a single inspiration, and this inhalation is 
practiced three or four times a day. In cases of acute and chronic 
coryza, great advantage is obtained by snuffing into the nares the 
fumes of arsenical cigarettes. The arsenite of antimony, according to 
Dr. Lucien Papillaud, is especially serviceable in pulmonary affections. 

When, in consequence of feebleness of the heart, there are present 
short breathing on making slight exertion, and oedema of the feet and 
ankles, especially as these symptoms occur in old people, arsenic is in- 
dicated. Attacks of angina pectoris may be lessened or prevented by 
the persistent use of arsenic in the interval. 

Certain disorders of the nervous system are greatly benefited by 
the use of arsenical preparations. The author has seen it extremely 
useful in cerebral congestion, for the treatment of which it was origi- 
nally recommended by Dr. Lemare-Picquot. It is indicated when there 
are commencing atheroma of the cerebral vessels, sluggish venous cir- 
culation, puffiness of the eyes, tendency to drowsiness, and intellectual 
torpor. In the melancholy and hypochondria of the aged, it gives great 
comfort, and frequently entirely dispels the gloomy fancies which take 
possession of the mind under these circumstances. The arsenic acts 
most favorably when combined with minute doses of opium ; viz., two 
drops of Fowler's solution, with three to five drops of tincture of opium, 
given three times a day. Arsenic is one of the remedies successful in 
the treatment of neuralgia. Generally its curative influence is indirect, 
and exerted through the improvement in the bodily nutrition which fol- 
lows its administration. It is directly curative, however, in the cases 
of hemicrania, and other neuralgim of malarial origin, but it holds a 
place strictly secondary to quinine in these affections. It is certainly 
one of the most effective remedies which we possess in the treatment 
of chorea. In this disease, large doses — five minims ter in die — must 
be given. Young subjects, it should be remembered, bear large doses 
of arsenic, relatively, better than adults. Cases of epilepsy have been 
reported cured by arsenic, but these were probably instances of epilepti- 
form vertigo caused by stomach-disorder, in which this remedy is un- 
doubtedly of great utility. Charcot has found the subcutaneous injec- 
tion of Fowler's solution of real value in parcdysis agitans. The same 
expedient has succeeded in local chorea and histrionic spasm. The in- 
fection should be made into the affected muscles, whenever practicable 



ARSENIC. 163 

Arsenic produces, in the course of its medicinal administration, affec- 
tions of the skin, and notably those dependent on an unknown state of 
the trophic nerves. In the treatment of various skin-affections we avail 
ourselves of this physiological fact, and set up by means of arsenical 
preparations a substitutive action in the skin. It follows, that arsenic 
will not be serviceable in acute affections of the skin, and experience 
demonstrates that, whenever active cell-proliferation is taking place, 
arsenic is contraindicated. It is most serviceable when the affection 
of the skin is superficial in its seat — in the epidermis and the superfi- 
cial layers of the derma. In cases of p>soriasis much good may be ex- 
pected from it, but, the more chronic the disease, the more beneficial 
is it. When the arsenic begins to exert an influence on psoriasis, the 
skin appears more inflamed, but this is an evidence that the curative 
action is taking place, and the remedy should then be persisted in. 
Acute eczema is rather exasperated by arsenic, but chronic eczema, 
especially eczema squamosum, is often greatly benefited by it. When 
eczema infests the vulva, anal region, and scrotum, arsenic is said to be 
useful, but its efficacy in these cases is largely determined by the chro- 
nicity of the attacks. Pemphigus is an affection of the skin which, as 
was more particularly shown by Mr. Hutchison, is curable by arsenic, 
but the more chronic the disease the more certainly beneficial the 
remedy. In old cases of acne, especially acne rosacea, arsenic is some- 
times serviceable, but it is often very disappointing. The author has 
not observed much good to follow the use of arsenic in the acne which 
occurs at puberty and for some years subsequently. In all cases of 
acne the strictest attention to diet and a proper hygiene is very im- 
portant. Arsenic given with bromide of potassium lessens or prevents 
the very disfiguring acne which appears in the course of the adminis- 
tration of that agent. Furuncle (boils) is successfully treated by the 
long-continued use of arsenic. This practice is strongly urged by 
Dr. Delioux de Savignac. A succession of boils is the indication for 
the use of this remedy. 

In the treatment of skin-affections, Fowler's solution is the arsenical 
preparation most frequently employed. The commencing dose need 
not be larger than five drops three times a day, given after meals. It 
is better to commence with the maximum dose, and to diminish the 
amount gradually. As arsenic needs to be administered for a long 
time in skin-diseases, such toxic symptoms as irritation of the eye- 
lids, puffiness of the eyes, and epigastric pain and soreness, are apt to 
arise. These symptoms are indications for the use of laxatives, and 
for a reduction in the dose of the remedy, but not for its entire sus- 
pension. In order to prevent relapses, the use of arsenic should be 
continued, in diminishing doses, for some time after the entire disap- 
pearance of the eruption. 

Arsenic is very useful in a certain form of chronic arthritis. The 



UU RESTORATIVE AGENTS. 

cases to which it is adapted are those in which the joints become tumid 
and stiff and painful in consequence of a peculiar state of the nervous 
svstem ; indeed, the condition is one allied to neuralgia, the trophic 
nerves being involved. This is a malady very different from that kind 
of chronic rheumatism or rheumatic gout which is accompanied by no- 
dosities of the joints, in which arsenic has been recommended, but over 
which, according to the experience of the author, it exerts no control. 

Arsenic has seemed to the author remarkably beneficial in diabetes 
of hepatic origin. It has also been found useful by Johannsohn. 
Arseniate of soda has lately been shown to be a very excellent remedy. 
It may usefully be given with phosphate of sodium — 3 j of the phos- 
phate and -^ of the arseniate of soda three times a day dissolved in 
warm water. At the present time Clemens's solution of bromide of 
arsenic is much in favor as a remedy for diabetes, and I therefore sub- 
join the formula for preparing it : Powdered arsenious acid and car- 
bonate of potassium, of each 57J grains ; boil in 8 ounces of distilled 
water until dissolved, and when cold make up to 11 \ troy ounces by 
sufficient distilled water. To this solution add 115 grains of pure 
bromine. The resulting solution should be well shaken several times 
a day during the first week. It should be colorless at the expiration 
of the fourth week, when it is fit for use. The dose is one drop three 
times a day, gradually increased to three drops. It should be given 
in about two ounces of water. Brunton reports good results from its 
administration in albuminuria, apparently due to defective digestion 
of albumen. 

Amenorrhoea, when due to functional inactivity of the ovaries, and 
menorrhagia, when produced by anaemia, are equally benefited by the 
preparations of arsenic, especially when combined with iron. Sperma- 
torrhoea, if dependent on a weak and relaxed state of the seminal vesi- 
cles, and functional impotence, are sometimes greatly improved by 
full doses of the arseniate of iron. 

Next to quinine, arsenic has the most important position in the 
treatment of malarial fevers. It may be used to prevent the recur- 
rence of attacks of ague when quinine for any reason is not admissible. 
As regards acute malarial toxaemia, arsenic is more useful as an ad- 
junct to quinine than as the sole remedy. The treatment of acute cases 
may be formulated as follows : large doses of quinine to interrupt the 
paroxysms, and at the septenary periods ; arsenic given daily to pre- 
vent relapses. It plays a more important role in chronic malarial dis- 
eases. As has been shown by Boudin, arsenic diminishes the engorge- 
ment of the spleen. The author has witnessed the rapid disappearance 
of malarial jaundice, and the cure of the alterations in the glandular 
appendages of the intestinal mucous membrane, under its use. It is 
most useful generally to combine iron with arsenic in the chronic form 
of malarial disease. t> Mas. ferri carbon., 3 j ; acidi arseniosi, gr. j. 



ARSENIC. 165 

M. Ft. pil. no. xx. Sig. : One three times a day. r> Quininse sulph., 
3 j ; ferri sulph. exsic, 3 j ; acidi arseniosi, gr. j. M. Ft. pil. no. xx. 
Sig. : One three times a day. Bond in justly insists upon abundant ali- 
mentation during a course of arsenical treatment of intermittents, and, 
with a view of preparing the digestive organs, administers a prelimi- 
nary emetic to relieve the stomach of the embarras gastrique. Arsenic 
has also been used as a prophylactic against malarial infection, and as 
a remedy for various intermittent diseases due to malarial influence. 
The author has seen excellent results from the use of small doses of 
Fowler's solution three times a day in typho-malarial fever. When 
there is much diarrhoea, a few drops of tincture of opium should be 
added to each dose of arsenic. In doses of half a drop to one drop of 
Fowler's solution, the tongue cleans, the skin becomes moist, and the 
delirium lessens sometimes in a most remarkable manner. When 
arsenic is used alone in the treatment of intermittents, large doses are 
necessary. Ten drops of Fowler's solution may be given after meals 
to adults, but in a few days — three, four, or five, according to the sus- 
ceptibility of the patient — the dose must be reduced two drops each 
day until four drops are reached. If the stomach does not become 
disordered, slight irritation of the conjunctivae and puffiness of the 
eyelids may be disregarded. 

There can be no doubt that the long-continued use of small doses of 
arsenic exercises a favorable influence over the course and progress of 
epithelioma. It has appeared, indeed, to be useful in scirrhus, especially 
as this morbid process manifests itself in the stomach. Rodent ulcer, 
which is closely allied in its nature to epithelioma, is also improved by it. 
With the internal use of the arsenical preparations may be conjoined 
the local applications of arsenious acid. Many physicians, notably the 
late Dr. Atlee, of Philadelphia, entertain the belief that the long- 
continued use of arsenic retards the growth of uterine cancer. Bill- 
roth reports a case of multiple lymphoma cured by the use of arsenic. 

External Uses of Arsenic. — An arsenical paste having the follow- 
ing composition is used to destroy the sensibility of a carious tooth : 
arsenious acid, ij ; sulphate of morphia, j ; sufficient creosote to make 
a paste. A small quantity of this is applied by a bit of cotton-wool 
to the carious portion of the tooth. 

Arsenious acid is sometimes employed to destroy cancerous growths. 
But, as it is extremely painful, and as the danger of absorption is great, 
other escharotics, as, for example, the chloride of zinc, are generally 
preferred. When it is used, the operator should be careful to employ 
an arsenical paste of sufficient strength to set up a limiting inflamma- 
tion, and thus prevent absorption. From one sixth to one fifth of 
arsenious acid is the proper proportion, and it may be mixed with 
calomel, starch, or other impalpable powder. If the surface to be de- 
stroyed is large, a portion of it should be submitted at a time to the 



166 RESTORATIVE AGENTS. 

action of the escharotic. Poultices should then be applied until the 
slough separates, when a healthy granulating surface is obtained. The 
excessive pain caused by the escharotic may be much alleviated by 
combining morphine and carbolic acid in the arsenical paste, or by the 
use of morphine hypodermatically until the escharotic action ceases. 

An arsenical paste prepared as follows is sometimes used as a de- 
pilatory : quicklime, 3 ss ; yellow sulphide of arsenic, grs. xx ; starch, 
3 ij. Sulphide of barium and oxide of zinc is a more efficient combi- 
nation. Esmarch's caustic is composed of : Arsenious acid, one part ; 
morphine sulph., one part ; calomel, eight parts ; and powdered acacia, 
forty-eight parts. Mix. Sprinkle thickly every day on a surface either 
raw or denuded of cuticle by a blister. 

In addition to the above local uses of arsenic, the results achieved 
by its hypodermatic injection should be mentioned. Dr. Radcliffe 
was the first to employ this practice in cases of local chorea of the 
head and neck, and in histrionic spasm. In these affections Fowler's 
solution or Pearson's, in doses of two to ten minims, diluted with an 
equal measure of water, is thrown into the affected muscles daily, 
sometimes curing after some weeks of treatment. In obstinate cases of 
general chorea the subcutaneous injection of arsenic is now practiced, 
with good effects, a cure resulting more speedily than by the stomachal 
method of administration. Arsenic used by this method has proved tc 
be the most effective remedy for lymphadenoma. 

Authorities referred to : 

Gathgens, C. Zur Kenntniss der Arsenicirkungen. Centralblatt f d. med. lYis., 82, 
1875, p. 529. 

Gies, Dr. Thomas. Experimentelle Untersuchungen iiber den Einfuss des Arsens auj 
den Organismus. Archiv fur experimentelle Path, und Pharm., vol. viii, p. 176. 

Grohe, Fr., und Mosler, Fr., Profs. Zur Kenntniss der Ver cinder ung en innerer Or- 
gctne bei ctcuter Arsenvergiftung. Virchow's Archiv, Band xxxiv, p. 208. 

Hebra, Prof. Dr. On Diseases of the Skin. Syd. Society edition, 1868. 

Hermann, Prof. Dr. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 224. 
Arsenverbindungen. 

Hoffman, Prof. Dr. Arsenikvergiftung und Cholera. Virchoio's Archiv, vol. 1, p. 455. 

Hunt, Thomas, Mr. On the Treatment of Chronic Diseases of the Skin. The Lancet, 
vol. i, 1846. 

Isnard, M. Bulletin General de ITierapeutique, vol. lxxxiv, p. 80. Ibid., vol. lxxii. 

Johannsohn, Nicolai. Ueber die Einwirkung der arsenigen Sciure auf Gahrungsvor- 
gdnge. Archiv fur experiment. Pathol, und Pharmacol., vol. ii, p. 99. 

Kossel, Albrecht. Zur Kenntniss der Arsenwirkungen in Prof. Gdthgens Labor, zu 
Rostock. Archiv f exper. Pathol, u. Pharm., vol. v, p. 128. 

Lesser, A. Archiv fur path. Anaiomie unci Physiologie, 1873, p. S9S, and 1S74, 
p. 603. 

Lolliot, M. Bulletin General de Therapeutique, vol. Ixxv, p. 338. 

Marme, W. Vergleichende Versuche iiber die Wirkungen der arsenigen Sciure und 
der Arsensaure. Abstract in Virchow unci Hirsch, vol. i, 1876. 

Marsden, Dr. Alexander. A New and Successful Jfode of treating Cancer, London, 
1869, p. 96. 



THE SIMPLE BITTERS. 167 

Ponteland Poisoning Cases. The Lancet, September 22, 1866, p. 337. 

Routh, Dr. C. H. F. Obstetrical Transactions, vol. viii, p. 290. 

Ringer and Murrell. Journal of Physiology, vol. i, p. 217. 

Scolosuboff, Dr. Sur la localisation de V arsenic dans les tissus d la suite de V usage 
des Arsenicaux. Archives de Physiol. Norm, et Path., vol. v, p. 563. 

Sklarek, Dr. W. Archiv fur Anal, und Physiologie, 1866, p. 41. The Physiological 
Effects of Arscnious Acid. 

Schafer, F., und Bohm. Ueber den Einfluss des Ar"sen auf die Wirkung ungeformtes 
Fermente. Virchow u. Hirsch, vol. i, 1872. 

Shulz, Dr. H. Weiterer Beitrag zur Theorie des Arsenwirkung . Archiv fur experi- 
ment. Pathologie u. Pharmacol., vol. xiii, p. 256. 

Unterberger, S. Mitgetheilt von Prof. Bohm. Beitrage zur Kenntniss der physiolo- 
gischen Wirkungen der Arsenigen Saure. Ibid., vol. ii, p. 89. 

Virchow, R. His Archiv, vol. xlvii, p. 524. Choleraahnlicher Befund bei Arsenik- 
vergiftung. 

THE SIMPLE BITTERS. 

Quassia. — Quassi amer, Fr. ; Quassienholz, Ger. The wood of 
Picrwna excelsa Lindley ( Quassia excelsa Swartz ; Nat. Ord. Simaru- 
bacece). 

Preparations. — Extraction Quassiw. Extract of quassia. Dose, 

g r - j— g r - iij- 

Tinctura Quassiw. — Tincture of quassia (10 parts to 100 of diluted 

alcohol). Dose, ft[ v — 3 j. 

Extractum Quassiw Fluidum. — Fluid extract of quassia. Dose, 
ttl v — 3 ss. 

Composition. — Quassia-wood contains a crystallizable bitter prin- 
ciple, neutral, called quassin. 

Gentiaiia.— Gentian, gentiane, Fr. ; Bitter wurzel, Ger. The root 
of Gentiana lutea Linne (Nat. Ord. Gentiaiiacew). 

Preparations. — Infusum Gentianw Compositum. (Not official.) 
Compound infusion of gentian. (Gentian, bitter orange-peel, corian- 
der.) Dose, 3 j — 1 j. 

Tinctura Gentianw Composita. — Compound tincture of gentian. 
(Gentian, bitter orange-peel, cardamom, alcohol.) Dose, 3 ss — 3 ij. 

Extractum Gentianw Fluidum. — Fluid extract of gentian. Dose, 
3 ss— 3 ij. 

Extractum Gentianw. — Extract of gentian. Dose, gr. j — gr. v. 

Composition. — Gentian contains a peculiar principle, gentianine } 
and an acid, gentisic acid. 

Gentiana Catesbsei. — Bine gentian, American gentian. This in- 
digenous remedy may be used as a substitute for the foreign gentian, 
and similar preparations to the official formula for gentian, as above, 
may be prepared from it. 

Unofficial Formulae. — Mistura gentianw alhalina. Dilute hy- 
drocyanic acid, TTj, iij ; bicarbonate of soda, grs. xv ; compound infu- 
sion of gentian to oz. j. 

Mistura Gentianw et Sennw. — Infusion of gentian, drachms vj ; 



168 RESTORATIVE AGENTS. 

infusion of senna, drachms iij ; compound tincture of cardamoms, 
drachm j. 

Calumba. — Colombe (raci?ie de), Fr. ; Muhricurzel, Ger. The root 
of Jateorrhiza calumba Meiers (Nat. Ord. Menispermacece). 

Preparations. — Infusum Calumba?. (Not official.) Infusion of 
calumba ( 3 j — Oj). Dose, \ ss — f ij. 

Tinctura Calwnbce. — Tincture of calumba (10 parts to 100 of di- 
luted alcohol). Dose, 3 ss — 3 ij. 

Fvtractum Calwnbce Fluidum. — Fluid extract of calumba. Dose, 
3 ss— 3 ij. 

Composition. — A peculiar principle, colombi?i, berberine, and a pe- 
culiar acid, colombic acid. 

Coptis. — Goldthread. The root of Coptis trifolia. There are no 
official preparations of coptis. It contains, in common with some 
other bitters, the alkaloid berberine, and another alkaloid in minute 
quantity which has been called coptine, closely allied to, if not iden- 
tical with, hydrastine. The tincture and fluid extracts are the best 
preparations. 

Sabbatia. — American centaury. Herb of Sabbatia angularis. As 
there are no official preparations of sabbatia, a tincture and fluid ex- 
tract made in accordance with the general instructions given in the 
United States Pharmacopoeia may be used. 

Cornus. — Dogwood. The bark of the root of Cornus Florida Linne 
(Nat. Ord. Cornacem). 

Preparation. — Extractum Cornus Fluidum, — Fluid extract of 
dogwood. Dose, th, x — 3 j. 

Decoctum Cornus Floridce. — (Not official.) Decoction of dogwood 
(ij— Oj). Dose, 1 ss — 1 ij. 

Antagonists and Incompatibles. — Quassia and calumba can be 
administered with the salts of iron. The sulphate of iron, and the sil- 
ver and lead salts, are incompatible with gentian. The infusion of 
coptis is not affected by the salts of iron, but is precipitated by the 
nitrate of silver and acetate of lead. Therapeutically, all those agents 
which promote waste or destructive metamorphosis are opposed to the 
action of the simple bitters. 

Synergists. — Iron, the mineral acids, pepsin, bismuth, etc., are 
synergistic to the bitters, and under some circumstances the alkalies 
promote their therapeutic action. 

Physiological Actions. — The simple bitters increase secretion 
from the mucous membrane. In the mouth they promote the flow of 
saliva, and in the stomach they appear to stimulate the production 
of gastric juice, and also of gastric mucus. It follows that an increase 
of digestive capacity is one result of their administration. The in- 
creased appetite which is observed from the use of the bitters is prob- 
ably due to two factors : the sense of bitterness which increases the 



THE SIMPLE BITTERS. 169 

desire for food, and the improved digestive power which, enabling more 
food to be disposed of, postpones the sense of satiety. Furthermore, the 
bitters, by removing morbid states of the intestinal mucous membrane, 
favor assimilation. More food being taken and more thoroughly digest- 
ed, it is obvious that the bitters promote constructive metamorphosis. 

The active constituents of some of them have been studied in 
detail. JBerberine, which enters into the constitution of several bitters, 
is possessed of some antiseptic and antiperiodic power, but is not ac- 
tive from the physiological point of view. In animals it causes low- 
ering of the blood pressure, and lessens body-heat (Curci). According 
to Kohler, it contracts the blood-vessels, and in the intestinal canal acts 
in a similar manner to the tannates. It is said, also, that when ap- 
plied to the walls of the intestines they contract energetically. Quas- 
sin has recently been studied by Dr. Campardou, and his observations 
were published in a special memoir. There are, however, no new facts 
produced. Quassin, as might be supposed from its origin, acts after 
the manner of the bitter tonics ; it increases the appetite, and pro- 
motes the digestive functions by stimulating the secretions of the 
gastro-intestinal mucous membrane, and the contractility of the mus- 
cular fiber of the intestine. In an overdose quassin causes the local 
and systemic symptoms of an irritant poison. 

Although these remedies, used judiciously and for a short period, 
undoubtedly promote the constructive metamorphosis, yet their long- 
continued use will produce gastric catarrh, decrease the flow of healthy 
gastric juice, and impair digestion. 

Therapy. — An infusion of coptis has much reputation in New Eng- 
land as a remedy in aphthoe, psoriasis of the mucous membrane, ulcers, 
and epithelioma, but it is probable that this supposed curative power 
is unfounded, and that it is no more useful than any bitter so applied. 

A few drops of the tincture of calumba, or a teaspoonful of the in- 
fusion, will sometimes greatly relieve the vomiting of p>regnancy, and 
is also occasionally efficacious in sea-sickness. The simple bitters are 
especially indicated in atonic dyspepsia, and in chronic gastric catarrh. 
They are useful in this state of things : pain after food, slow diges- 
tion, constipation, alternating with diarrhoea. Calumba is the mildest, 
and may be borne when quassia and gentian disagree. According to 
Wilson Fox, " calumba holds the chief place in point of therapeutic 
value as a remedy which can be safely employed when others of the 
class would be too irritating." When there are much relaxation and 
torpor, quassia is very useful as a stomachic tonic. Sometimes an ex- 
temporaneous cold infusion of quassia is used, made by filling over- 
night with cold water a quassia-cup — a goblet turned out of quassia- 
wood. When constipation exists in cases of atonic dyspepsia, good 
results are obtained by a combination of gentian with senna, as in the 
formula already given. The compound tincture of gentian is an ex- 



170 RESTORATIVE AGEXTS. 

celleiit vehicle for the administration of cod-liver oil, and contributes 
to its digestion and assimilation. 

The infusions of gentian, calumba, and quassia are usefully em- 
ployed as vehicles for the administration of acids and alkalies in cases 
of acidity and deficient supply of gastric juice, under the rules given 
in the articles on acids and alkalies. 

In convalescence from acute diseases, the simple bitters, especially 
gentian and calumba, are employed to promote the appetite and diges- 
tion, and thus to aid in the process of constructive metamorphosis. 

In the diarrhoea which is due to relaxation of the mucous mem- 
brane, and is not dependent on inflammation, the tincture of calumba 
is often useful. The author has obtained good results from the use 
of tincture of calumba combined with opium in the treatment of an 
irritable state of the intestinal mucous membrane, indicated by these 
symptoms : Soon after taking food, the occurrence of pain referable 
to the small intestines, nausea, loose evacuations containing undigest- 
ed aliments, and followed by weakness and depression. ^ Tinct. ca- 
lumbaB, 3 xv ; tinct. opii deodor., 3 j. M. Sig.: A teaspoonful in a 
wineglassful of water before meals. Calumba is also serviceable in 
the relaxation of the bowels succeeding to acute affections of the in- 
testinal mucous membrane. 

The infusion of quassia is one of the most effective injections for 
the destruction of the ascarides vermiculares which infest the rectum. 
The stomach administration of simple bitters undoubtedly hinders the 
development of intestinal worms, probably by correcting a morbid 
state of the mucous membrane. In the treatment of intestinal para- 
sites much good, therefore, is derived from the use of bitters, admin- 
istered with the view of restoring normal digestion. 

According to "Wood, the remedy most effective to remove and 
" permanently cure a disposition to the accumulation of flatus hi the 
boicels is an infusion made with half an ounce of calumba, half an 
ounce of ginger, a drachm of senna, and a pint of boiling water, and 
given in the dose of a wineglassful three times a day." 

The bitters are used as remedies in malarial fever. Although they 
exercise but little influence over the course of intermittent and remit- 
tent fever, they are useful in the form of infusion as vehicles for the 
administration of more active drugs. In the convalescence from mala- 
rial fever, and in chronic malarial poisoning, they are more actively 
beneficial as agents promoting constructive metamorphosis. The dog- 
wood, of all the bitters given in the above list, possesses the most 
positive antiperiodic qualities, and is considered by the physicians of 
Southern United States as next to quinine in efficiency. An excellent 
tonic combination of decided utility in chronic malarial disease is the 
following : Dogwood-bark, calumba, poplar (liriodendron), wild-cherry, 
of each six ounces ; boneset (eupatorium) and cayenne pepper, of each 



AROMATIC BITTERS. 171 

four ounces. Mixed and sifted. Of the mixture a teaspoonful in 
cold or warm water, three or four times a day. A useful tincture to 
serve the purpose of a tonic, and as a remedy in malarial affections, 
may be prepared from the above combination of bitter tonics. 

AROMATIC BITTERS. 

Serpentaria. — Virginia snakeroot. Serpentaire de Virginie, Fr. ; 
Schlangenwurzel, Ger. The rhizoma and rootlets of Aristolochia ser- 
pentaria and of Aristolochia reticulata Nuttall (Nat. Ord. Aristolo- 
chia), U. S. P. 

Preparations. — Infusum Serpentarice. — Infusion of serpentaria 
( I ss — Oj). Dose, % ss — § j. (Not official.) 

Tinctura Serpentariw. — Tincture of serpentaria ( | iv — Oij). Dose, 
3 ss — 3 ij. 

Extractum Serpentarim Fluidum. — Fluid extract of serpentaria. 
Dose, 3 ss — 3 ij. 

Composition. — A volatile oil, resin, a bitter principle, etc. 

Primus Virginiana. — Wild cherry. The bark of Prunus serotina. 

Preparations. — Bifusum Pruni Virginianm. — Infusion of wild- 
cherry ( § ss — Oj). Dose, | ss — § ij. 

Extractum Pruni Virginianm Fluidum. — Fluid extract of wild- 
cherry bark. Dose, 3 ss — 3 j. 

Syrupus Pruni Virginianm. — Sirup of wild-cherry. Dose, 3 j — 

3 ij- 

Composition. — Amygdalin and emulsin, which produce by their 
reaction hydrocyanic a^c,id, tannic and gallic acids, etc. 

Cascarilla. — Cascarilla. Cascarille, Fr. ; Cascarille Pinde, Ger. 
The bark of Croton Eleutheria Bennett (Nat. Ord. Euphorbiacem) . 

Preparations. — Infusum Cascarillm. (Not official.) Infusion of 
cascarilla ( f j — Oj). Dose, § ss — § j. 

Composition. — A crystallizable principle, cascarillin, tannic acid, 
a volatile oil, etc. 

Canella. — The bark of Canella alba. This remedy was dropped 
from the list of official medicinal agents in the " Pharmacopoeia " of 
1880. As it is indigenous (Florida), and as recent experiences have 
shown that it is possessed of some valuable therapeutical properties, 
it is taken up now as a member of the group of aromatic bitters. 

Composition. — Canella contains a volatile oil and a bitter princi- 
ple, but the latter has not yet been isolated. 

Actions and Uses. — These remedies possess the quality called tonic ; 
they invigorate digestion, and promote constructive metamorphosis. 
They differ from the simple bitters in containing aromatic constituents, 
and in being astringent to a greater or less degree, owing to the pres- 
ence of tannic and gallic acids. They are indicated in the same kind 
of cases as, and under similar conditions to, the simple bitters ; but 



172 RESTORATIVE AGENTS. 

they are supposed to have, in addition, some specific properties derived 
from their volatile and odorous constituents. 

Serpentaria is occasionally used as a stimulating tonic in typhoid 
and typho-malarial fevers. It is more frequently prescribed as a 
stimulant expectorant in capillary bronchitis and in pneumonia of 
low grade, when carbonate of ammonia is combined with it. For- 
merly it was used locally to the throat, as a gargle in diphtheria, and 
given internally as a stimulant, but it is now very rarely employed in 
such cases. 

Wild-cherry is an excellent stomachic tonic, and may well be used 
as a substitute for calumba in the class of cases to which the latter is 
considered specially applicable. It has long been held in great esteem 
in domestic practice, as a remedy in catarrhal states of the bron- 
chial mucous membrane, and in phthisis. Owing to the prussic acid 
which its cold infusion contains — produced by the reaction between 
the amygdalin and emulsin — it exercises some influence over cough. 
That it has any special virtues in the treatment of phthisis is hard- 
ly to be credited. The sirup is much used as an ingredient in cough- 
mixtures. 

As regards canella, there has been no proper study of its physio- 
logical actions. The success which has, apparently, attended its use in 
certain hemorrhagic states indicates that canella has properties analo- 
gous to erigeron : antiseptic, vaso-motor, stimulant, etc. Formerly, it 
was in considerable repute as a remedy for certain pelvic disorders in 
women, and was much prescribed in the form of hiera p>icra (vulgarly 
hickery pickery), pulvis aloes cum canella. Recently, Dr. Cheron has 
revived its use, and extols it much as a remedy for menorrhagia and 
metrorrhagia of chlorosis, for the menorrhagia occurring during preg- 
nancy in weak, lymphatic women, for the menorrhagia of cancer, and 
for the persistent bleeding after delivery, due to the inefficient invo- 
lution of the uterus, in some weak subjects. It is also often highly 
useful in the dysmenorrhea of congestion, and the amenorrhoea of 
similar origin. If constipation coexist, the combination with aloes 
acts well. 

Authorities referred to : 

Cheron, Dr. J. Revue de Therapeutique, October 15. 1885, p. 350. 
Husemax, Drs. August und Theodor. Die Pflanzenstoffe, op. cit. 
Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, Charles- 
ton, 1869. 

Oleum Eeigerontis. — A volatile oil obtained from Erigeron hete- 
rophyllum, E. Philadelphicum, and E. Canadense. 

Oleum Erechthites. — A volatile oil obtained from Erechthites 
hieracifolius (fireweed). 

I am informed by Prof. J. U. Lloyd, the distinguished pharmacist 



OLEUM ERIGERONTIS— OLEUM ERECIITIIITIS. 173 

of Cincinnati, that the oil of erigeron is much adulterated with the 
oil of erechthites (fire weed). As these volatile oils have similar 
properties physiologically, there is probably no great harm done by 
the substitution. I am indebted to Prof. Lloyd for pure^ specimens 
of each. They differ in odor and in appearance. Erigeron-oil is 
reddish yellow in color, while erecthites is pale yellow, or nearly 
colorless. 

Properties. — These oils are hot and somewhat pungent to the 
taste, and give off a characteristic odor. They grow darker in color, 
and thicker in consistence, by age. They are soluble in ether and in 
absolute alcohol. The principal constituent is a terpene. 

The ordinary dose is five drops, or from three to ten drops, 
and the best mode to administer the oil is to drop the dose on 
a lump of sugar, and swallow with a large draught of water, or 
it may be put into gelatine capsules, or made into an emulsion 
with gum. 

Actions. — Oil of erigeron has long been known to have consider- 
able power to arrest haemorrhage, but a knowledge of this fact has 
been confined to a few physicians of Philadelphia, and has not been 
acted onto any considerable extent. No adequate explanation has 
been offered of the nature of this property. Some recent investiga- 
tions have satisfied me that the physiological actions consist in stimu- 
lation of the vaso-motor system, and at the same time of the inhibitory 
function of the vagus terminals. In consequence of these effects the 
amount of blood passing through the arterioles in a given time is 
much lessened. 

Erigeron-oil, also, stimulates the renal functions, and promotes the 
cutaneous transpiration — both effects being due, probably, to contact 
with these organs during the process of elimination. 

Oil of erigeron has considerable antiseptic power, prevents decom- 
position, and is destructive of microbes to some extent. There are 
other agents, however, more powerful as germicides, but under some 
circumstances erigeron-oil may be utilized for this purpose. 

Therapy. — Recent experiences have confirmed former opinions 
that erigeron-oil has a distinct antihgemorrhagic property. In me- 
norrhagia and metrorrhagia it has proved very effective in nu- 
merous instances, but it sometimes fails. In purpura it is distinct- 
ly beneficial. In fact, whenever haemorrhage is more especially 
venous in character, in what site soever it may occur, erigeron is 
likely to do good. 

The author has ascertained, also, that oil of erigeron is, in a high 
degree, useful in the chronic forms of albuminuria. It lessens the 
waste of albumen, sometimes remarkably, and at the same time im- 
proves the general condition of the patient. An acute congestion of 
the kidneys is probably a contraindication to its use, but in all the 



174 RESTORATIVE AGENTS. 

really chronic cases, united by the common symptom — albuminuria — 
it may be expected to render real service. 

In catarrh of the genito-urinary mucous membrane, pyelitis, cys- 
titis, etc., it has acted well, probably, because of coming into actual 
contact with the mucous membrane in the process of elimination. In 
small doses it has apparently allayed irritability of the bladder, as it 
occurs in women, and the author has seen it give much relief in cases 
of prostatic irritation. 

As a stimulant expectorant, erigeron-oil is entitled to much con- 
sideration. It is nearly, if not quite, as useful in chronic bronchitis, 
icinter cough, etc., as is terebene, and may be given under the same 
conditions, and to supply the same indications. Here, again, the ex- 
planation of its utility may be found in the actual contact with the 
diseased surface which takes place in the process of elimination. 

Authorities referred to : 

Bartholow, Dr. R. The Physician and Surgeon, Ann Arbor, April, 1887. 

Eucalyptus. — Leaves of Eucalyptus globulus Labillardiere (Nat. 
Ord. Myrtacem). 

Preparations. — Tinctur a Eucalypti. (Not official.) Tincture of 
eucalyptus. Dose, 3 ss — 3 ij. 

Extractum Eucalypti Fluidum. — Fluid extract of eucalyptus. 
Dose, ni x — 3 j. 

Oleum Eucalypti. — Dose, flf v — 3 ss. Usually prescribed in cap- 
sules, but may be given in the form of emulsion. 

Composition. — Eucalyptus contains a peculiar resin composed of 
three different resinous bodies, a volatile oil consisting of eucalyptol, 
terpene, and cymol, tannic acid, and a crystallizable fatty acid. Euca- 
lyptol is the most important of the constituents. 

Antagonists and Incompatibles. — Alkalies, the mineral acids, 
the salts of iron, mercury, lead, zinc, etc., are chemically incompatible. 
All agents promoting waste, or the retrograde metamorphosis of tis- 
sue, are therapeutically incompatible. 

Synergists. — The simple and aromatic bitters, hydrastis, cinchona, 
etc., camphor, turpentine, cubebs, copaiba, the essential oils and sub- 
stances containing them, are synergistic to or promote the therapeuti- 
cal actions of eucalyptus. Any of these remedies may, therefore, be 
prescribed in the same formula with eucalyptus. 

Physiological Actions. — Eucalyptus has a warm, aromatic, bitter, 
and camphoraceous taste, resembling somewhat the taste of cubebs. 
In the mouth it excites the flow of saliva, and leaves a hot, pungent, 
and rather disagreeable flavor. In the stomach it causes a sensation 
of warmth, and doubtless promotes the flow of gastric juice. The 
appetite and digestive power are increased under its use. Increased 
intestinal secretion, also, is one result of its administration, and hence 



EUCALYPTUS. 175 

the alvine evacuations are rendered somewhat more copious and easy. 
In very large doses it causes a sense of weight and uneasiness at the 
epigastrium, odorous eructations and indigestion, followed by diarrhoea, 
the stools having the characteristic odor of eucalyptol. The essential 
oil is readily diffusible and enters the blood with facility, but what 
changes, if any, it induces in the blood are unknown. It increases the 
action of the heart, lowers the arterial tension, and induces a feverish 
state. The respiratory movements are accelerated. Wakefulness is 
caused by it in those of full health, and sleep in the weak and ansemic. 
The eucalyptol is eliminated by the skin, mucous membrane of the 
bronchial tubes, and by the kidneys, the secretions of these organs 
being increased by it, and they are impregnated with its odor. This 
is especially the case with the urine, which, after some days' adminis- 
tration, becomes most strongly odorous by the presence of eucalyptol. 

The vapor of eucalyptus, inhaled in large quantity, produces analo- 
gous effects to the internal administration, besides the more decided 
effects on the bronchial mucous membrane. 

Eucalyptus is a powerful diaphoretic. 

Therapy. — The decoction of the leaves is an efficient local appli- 
cation in the various forms of stomatitis, angina subacute and chronic, 
and tonsillitis after the subsidence of the acute stage. 

Eucalyptus is one of the most useful of the so-called stomachics in 
atonic dyspepsia, chronic gastric catarrh, and chronic intestinal ca- 
tarrh, but its use is contraindicated in inflammatory states. The form 
of vomiting and indigestion dependent on the presence of sarcina is 
relieved by this agent, which acts by destroying the vitality of this 
minute organism. That condition of the mucous membrane which 
favors the production of intestinal parasites is removed by eucalyptus. 
In the case of ascarides vermiculares, the remedy should be used by 
injection. 

Like the bitters, eucalyptus may be used to promote constructive 
metamorphosis, but it possesses more decided stimulant effects than 
these agents, by virtue of the eucalyptol. In convalescence from acute 
disease, in debility arising from defective assimilation, and in cachectic 
states generally, it is a serviceable tonic and stimulant. When the ac- 
tion of the heart is weak, it may be strengthened by eucalyptus. To 
women at the change of life who suffer from flatidence, palpitation of 
the heart, and sudden flushings of the face, it affords great relief, and 
often permanently removes these symptoms. 

Hysteria, chorea, asthma, and allied nervous states, when occurring 
in debilitated subjects, and cerebral anwmia, are benefited by eucalyp- 
tus. In asthma eucalyptus may be smoked in cigarettes with stramo- 
nium, belladonna, tobacco, etc. Its efficacy in the form of fumes is 
strongly stated by Maclean. 

The most important uses of this agent occur in the treatment of 



176 RESTORATIVE AGENTS. 

catarrhal affections of the broncho-pulmonary mucous membrane. It 
is not adapted to acute affections or to recent inflammation, but to 
chronic cases accompanied by free muco-purulent expectoration. The 
author is able to confirm the observations of Gubler in reference to the 
great utility of eucalyptus in bronchorrhcea. It is an interesting fact, 
and probably explanatory of its therapeutical action, that eucalyptol is 
in part eliminated by the bronchial mucous membranes. In the same 
way eucalyptus is effective in the treatment of catarrhal states of the 
genito-urinary organs. Chronic desquamative nephritis, granular de- 
generation of the kidneys, pyelonephritis, and hydronephrosis, are im- 
proved by its cautious administration, but it should not be forgotten 
that, used too freely, or for too great a length of time, it will cause 
irritation and congestion of the kidneys, in the same way that turpen- 
tine, copaiba, and cubebs do. 

No remedy which the author has hitherto used has seemed to him 
so effective in chronic catarrh of the bladder as eucalyptus. The urine 
during its administration acquires a strong odor of eucalyptol, and to 
its local action on the mucous membrane is to be attributed the thera- 
peutical effect. 

Eucalyptus has been much praised as a remedy for intermittent 
fever. The evidence as to its utility is contradictory. As the result 
of his own observations, and after careful examination of the facts 
reported by others, the author concludes that eucalyptus is far inferior 
to quinine. It is certainly very serviceable in the convalescence from 
intermittent and remittent fevers, and in chronic malarial poisoning it 
has a high degree of utility. It can not take the place of quinine for 
the arrest of the paroxysms, or to prevent relapses at the septenary 
periods, but it is more useful than quinine to reconstruct the damages 
in the organs of assimilation caused by malarial infection. 

Externally, the tincture and the distilled water of eucalyptus are 
used as disinfectant applications to foul-smelling and ill-conditioned 
ulcers and wounds (Gimbert). The water of eucalyptus is recom- 
mended by Gubler as a vehicle for agents used by the hypodermatic 
method. The toxic influence of eucalyptus on the lower forms of life 
— cryptogamic and infusorial organisms — is the ground of its applica- 
tion for these purposes. As respects solutions of alkaloids for hypo- 
dermatic use, the water of eucalyptus prevents the development of the 
p>enicillium, which grows rapidly and at the expense of the alkaloid 
in solutions prepared with simple distilled water. 

Authorities referred to : 

Burdel, Dr. E. Bulletin de Therapeutique, tome lxxxiv, p. 409, et ibid., tome lxxxv, 
p. 529. 

Costau, M. Gazette Hebdomadaire, 1872, No. 25. Bulletin de Therapeutique, tome 
Ixxxiii, p. 237. 

Gimbert, M. le Dr. Bulletin de TJierapeutique, tome lxxxii, p. 422. 



HYDRASTIS. 177 

Gubler, Dr. A. Bulletin de Therapeutique, tome lxxxi, pp. 145, 193. 

Keller, Dr. The British Medical Journal, May 11, 1872. 

Lorinser, Dr. Wiener medicinische Wochenschrift, 1869, xix, 43. 

Maclean, Dr. M. C. The Practitioner, y 61. vii, p. 268. 

Schmidt's Jahrbucher der gesammten Medicin, vol. cxlviii, p. 11. Ueber Eucalyptus 
Globulus ; nach F. W. Lorinser ; C. Haller ; Franz Seitz ; L. A. Buchner ; C. Paul ; A. 
Gubler. 

Ibid. Yol. cl, p. 121. Ueber den Nutzen des Eucalyptus gegen Wechseljieber. 

Hydrastis. — The rhizoma and rootlets of Hydrastis Canadensis 
Linne (Nat. Ord. Ranunculaceaz). Yellow-root. 

Prepaeations. — Extractum Hydrastis Fluidum. Fluid extract of 
hydrastis. Dose, fn,v — | ss. 

The colorless fluid extract, as made by Lloyd, of Cincinnati, is a 
more eligible preparation than the official. It is free from berberine 
and other coloring-matters, but is rich in hydrastine, and is more 
active than the regular fluid extract. 

Tinctura Hydrastis. — Tincture of hydrastis. Dose, nix — 3 j. 

Composition. — Hydrastis contains a peculiar principle, hydrastine 
or hydrastina, which crystallizes in four-sided prisms, white or color- 
less when pure, and having but little taste. Hydrastine, the alkaloid, 
should not be confounded with the eclectic preparation, " hydrastin," 
which is composed chiefly of berberine. Much of the peculiar virtues 
of hydrastis is probably due to the alkaloid berberine, which is con- 
tained in it in the proportion of about four per centum. Both of these 
alkaloids unite with acids to form salts. The salts of hydrastine are 
not crystallizable. 

Antagonists and Incompatibles. — The alkalies, tannic and muri- 
atic acids, are chemically incompatible with the preparations of hy- 
drastis. Muriatic acid precipitates berberine, and the so-called hy- 
drastine of the eclectic practitioners is nothing more than berberine 
muriate. The alkaloid hydrastine is antagonized by chloral, which is, 
therefore, the appropriate remedy in poisoning by this agent. 

Synergists. — The vegetable tonics in general are synergistic to 
hydrastis, especially berberis vidgaris and calumba, both of which con- 
tain berberine, and the group of excito-motors favor its action. 

Physiological Actions. — The preparations of hydrastis have a 
decidedly bitter taste, and, like other bitters, promote the flow of saliva, 
and probably, also, of gastric juice. Increased appetite and digestive 
power result from its administration. It is, therefore, a stomachic 
tonic. It also increases secretion of the intestinal mucous membrane. 

The property of hydrastis as a laxative is due to its effects on the 
various secretions concerned in the primary assimilation, whence the 
stools become softer, and to its stimulant action on the muscular fiber 
of the intestine, whence it increases peristalsis. Until the author's in- 
vestigations were made in the laboratory of Jefferson Medical College, 
13 



ITS RESTORATIVE AGENTS. 

only vague impressions existed as to the character of its true active 
principle — hydrastine. 

The most conspicuous effect of the alkaloid is the stimulation of 
the nervous system of animal life, and this power is exerted on cold- 
and warm-blooded animals, and on man in a uniform manner. Com- 
parative tests demonstrated that the alkaloid and the fluid extracts, 
colored and colorless, acted in the same way — hence it follows that 
hydrastine is the true active principle, and that berberine contributes 
nothing to the impression made on the nervous system, although the 
stomachic tonic and cholagogue actions must be, in part, certainly re- 
ferred to this alkaloid. 

The most important and characteristic effect of the alkaloid — hy- 
drastine — is that which it exerts on the nervous system of animal life ; 
it is an excito-motor stimulant, and induces such a degree of excita- 
bility of the reflexes that the feeblest peripheral irritation causes gen- 
eral tonic muscular spasms, passing from above downward. Presently 
these tetanic convulsions occur independently, and in the interval be- 
tween them more or less muscular trembling and paresis occur. This 
tetanizing action was found to be due to an impression on the spinal 
cord — is centric and not peripheral in seat. When very large doses 
are administered, the irritability of the motor nerves is destroyed and 
the muscular contractility impaired to some extent. Death ensues 
by tetanic fixation of the respiratory muscles, and hence increasing 
cyanosis and carbonic-acid narcosis occur. 

In medicinal doses (medium) hydrastine stimulates the vagus, but 
lethal doses destroy its irritability, and the heart's action is arrested in 
the diastole, the cavities distended. It is then found that the cardiac 
muscular tissue will no longer contract on electrical stimulation. In 
ordinary medicinal doses hydrastine stimulates the vaso-motor system 
causes contraction of the arterioles, and raises the arterial tension ac- 
cordingly, but in massive or lethal doses the opposite effects obtain. 

Comparative experiments have shown that hydrastine not only has 
many points of correspondence in its physiological actions to strych- 
nine, but its physiological antagonists are the same. The most impor- 
tant of the antagonisms is that between hydrastine and chloral. When 
the tetanizing action of the former is well advanced, chloral suspends 
the spasms, and thus prevents the tetanic fixation of the respiratory 
muscles, which is the mode of dying. 

The elimination of hydrastine is effected chiefly by the kidneys, and 
to some slight extent, probably, by the intestinal glands. 

Therapy. — Stomatitis, both mercurial and aphthous, is much im- 
proved by local application of the fluid extract of hydrastis. When 
this preparation causes much smarting, it may be diluted with water. 
Follicular pharyngitis, chronic coryza, and even syphilitic affections of 
the mouth, throat, and nares, may be much benefited or even cured by 
the same application. It is said that five to ten drops of the fluid ex- 



HYDRASTIS. I79 

tract, taken by the stomach, will act favorably in the removal of the 
very troublesome affections named above, but the author is unable to 
verify these observations. 

Hydrastis is very useful as a stomachic tonic, and may take the 
place of calumba in the treatment pf atonic dyspepsia. A few drops 
of the tincture or fluid extract (five to fifteen) taken before meals, 
daily, for some time, will often cure chronic gastric catarrh, and re- 
move the distressing headache which frequently accompanies this dis- 
ease. It is one of the best remedies for the stomach catarrh of chronic 
alcoholism, and is probably the best substitute, if given in sufficient 
doses, for the alcoholic stimulant when its habitual use is to be aban- 
doned. Catarrh of the duodenum is in a similar manner relieved by 
hydrastis, but this agent has special utility in duodenal catarrh when 
accompanied by catarrh of the gall-ducts and jaundice. Its use should, 
in these affections, be continued for some time. 

These statements have been questioned by the authors of a dispen- 
satory, the therapeutical part of which is chiefly remarkable for an 
elaborate nihilism. Quoting one of the foregoing sentences, the medical 
skeptic in question asserts that such confidence in the value of hydras- 
tis indicates " marvelous virtues " in the remedy, or " still more mar- 
velous faith " in those who make such assertions. It is unfortunate 
that mere library therapeutists should have the opportunity to air their 
crude conceptions and parade their uninstructed judgments in a big 
volume intended for the perusal of students and young physicians. 
The alkaloid hydrastine having the power to stimulate the motor cen- 
ters of the nervous system, while it also acts on the gastro-duodenal 
mucous membrane, is peculiarly fitted to relieve that complex of con- 
ditions included in the term chronic alcoholism. It is the combina- 
tion of these powers that renders it a valuable restorative when the 
use of alcohol is discontinued. 

When constipation is dependent on deficient secretion, and the 
stools are dry and hard, it may be overcome by this remedy, but tor- 
por of the muscular layer of the intestine is not affected by it. 

Chronic catarrh of the intestine, even when it has proceeded to 
ulceration, is sometimes remarkably benefited by hy/Irastis. When 
the stools are very frequent and there is much pain, it is advantageous 
to combine a little opium with it. In fissure of the anus, haemorrhage 
from the rectum, and idceration of the rectal mucous membrane, appli- 
cations of fluid extract of hydrastis to the affected parts promote healing. 

As a remedy for inter mittents, hydrastine ranks far below quinine. 
In chronic malarial poisoning (paludal cachexia), hydrastine may be 
given with ferruginous preparations, as quinine is so frequently em- 
ployed. Although not without action, it is inferior to quinine in the 
condition of enlarged spleen of malarial origin. 

Late researches have shown that berberine has an injurious effect on 
the kidneys, and must therefore be avoided ; but hydrastine may be used 



ISO RESTORATIVE AGENTS. 

with advantage in certain affections of the genito-urinary organs. In 
chronic Brig hi? s disease it appears to lessen the excretion of albumen. 
It diminishes the mucus in catarrh of the bladder. It is often a useful 
remedy in gonorrhoea after the acute stage has subsided, and in gleet. 

Hydrastine having the power to stimulate the excito-motor func- 
tions of the spinal cord, may be expected to do much good in cases of 
paresis or paralysis of motility when the lesions causing them are not 
recent in origin. Those forms of paralysis with trophic disturbances, 
which succeed to fevers and other acute affections, are conditions of 
disease in which it may be expected to do good. Reflex neuroses 
having their origin in gastro-intestinal catarrh, respiratory neuroses 
of a paretic character, and similar maladies requiring an excito-motor, 
will probably be successfully treated by hydrastine. 

Prof. Schatz finds hydrastis a valuable remedy in the haemorrhage 
of uterine myomata, in menorrhagia, in congestive dysmenorrhoea, 
and allied states. Its power to stimulate the organic nervous system, 
and thus to contract the blood-vessels, is Schatz's explanation of its 
mode of action. 

The lethal quantity of hydrastine not having been determined, the 
dose can not be closely stated. It is probable that, beginning with ^j- 
gr., the dose may be increased up to £th or even J grain. 

Local Uses. — Uterine and vaginal leucorrhoea, ulcerations, and 
erosions of the cervix uteri, are quickly improved by the topical ap- 
plication of the fluid extract of hydrastis, which may be used in an 
undiluted state. 

Unhealthy and sloughing sores, chancroid, old idcers of the leg, 
are improved in character by the local use of this remedy. 

Authorities referred to : 

Bartholow, Dr. R. Lloyd's Drugs and Medicines of North America, vol. i. 
Filehne, Dr. Quoted in London Medical Record, November 15, 1884. 
Porcher, Dr. F. Peyre. Resources of the Southern Fields and Forests, Charleston, 
1869, p. 15. 

Schatz, Prof. Centralblatt fur gesammte Therapie, Band ii, p. 82. 
Sclav atinsky, Dr. London Medical Record, supra. 



CINCHONA AND ITS PREPARATIONS. 

Cinchona. — Cinchona. The bark of any species of cinchona (Ru- 
biacese) containing at least three per cent of its peculiar alkaloids. 

Cinchona Flava. — Yellow cinchona (calisaya-bark). The bark of 
Cinchona calisaya. It should contain not less than two per cent of 
alkaloids which yield crystallizable salts. 

Cinchona Rubra. — Red cinchona. The bark of Cinchona succi- 
rubra. It should contain not less than two per cent of alkaloids 
which yield crystallizable salts. 



CINCHONA. 181 

Preparations. — Decoctum Cinchotice Flavce. Decoction of yellow 
cinchona ( § j — Oj). Dose, § ss — § j or more. 

Infusum Cinchonce. — Infusion of cinchona (cinchona, yellow bark, 
unless specified, 6 parts ; aromatic sulphuric acid, 1 part ; water to 
make up 100 parts). Dose, 3 j — 1 j or more. 

Extractum Cinchonce. — Extract of cinchona (cin. flava). Dose, 

Extractum Cinchonce Fluidum. — Fluid extract of cinchona. Dose, 
TT[ x — 3 j or more. 

Tinctura Cinchonce. — Tincture of cinchona (yellow cinchona, 20 
parts to 100 of alcohol, glycerin, and water). Dose, 3 ss — 3 ij. 

Tinctura Cinchonce Composita. — Compound tincture of cinchona 
(red cinchona, 10 parts ; bitter orange-peel, 8 parts ; serpentaria, 2 parts ; 
alcohol, glycerin, and water, to make 100 parts). Dose, 3 j — 1 ss. 

Cinchonince Sulphas. — Sulphate of cinchonine ; occurs in white, 
shining crystals ; dissolves in fifty -four parts of cold water, in much 
less boiling water, in seven parts of alcohol, and very sparingly in 
ether. Dose, gr. v — 3 ss. 

Quinince Sulphas. — Sulphate of quinine ; occurs in colorless, very 
light, and silky crystals ; is entirely dissolved by about seven hundred 
and forty parts of cold, or thirty of boiling water, is readily soluble in 
alcohol, and in water acidulated with sulphuric acid, but is insoluble 
in ether. Dose, gr. j — 3j. 

Quinince Valerianas. — Valerianate of quinine. A colorless salt, 
crystallizable, and having a peculiar odor and bitter taste ; is soluble 
in one hundred and ten parts of cold, or in forty parts of boiling water, 
and in six parts of cold alcohol. Dose, gr. j — 3j. 

Pilulce Quinince Sulphatis. — Pills of sulphate of quinine. Each 
pill contains one grain. 

Chinoidinum. — Chinoidin. Formerly called, also, quinoidin. " A 
mixture of alkaloids, mostly amorphous, obtained as a by-product in 
the manufacture of the crystallizable alkaloids from cinchona." This 
preparation occurs in cylindrical black masses, rather brittle when 
cold, but resinous and plastic when warm ; is very bitter to the taste ; 
alkaline in reaction, little soluble in water, but freely soluble in alco- 
hol. Dose, gr. v— 3 j. 

Composition. — Cinchona is remarkable for the number and variety 
of the principles obtained from it, viz., five alkaloids, two simple acids, 
two tannic acids, and a resinoid substance. The most important alka- 
loid is quinine, which exists in all varieties of bark, but is most abun- 
dant in the yellow or calisaya bark. It occurs in combination with 
kinic and kino-tannic acids. Quinidine is an alkaloid isomeric with 
quinine, and may be used as a substitute for the latter in the same 
dose. It is less bitter than quinine, and its sulphate is more soluble in 
water. Cinchonine is found in greatest quantity in the pale barks. 



1S2 RESTORATIVE AGENTS. 

It unites with acids to form salts, of which the sulphate is most fre- 
quently used. Therapeutically considered, cinchonine has about half 
the strength of quinine. Cinehonidine is an alkaloid isomeric with 
cinchonine, as quinidine is with quinine. Ariei)ie, which has close anal- 
ogies with cinchonine, has been found in the aricia or Cusco bark. 

The alkaloids are combined in bark with the acids Tcinie au&kino- 
vic, chiefly with the former. There are also two kinds of tannic acid, 
kino-tan nic and kinovi-tannic, and a resinoid substance, Mnovin. 
None of these have thus far been applied to therapeutical purposes, 
except kinic acid, which has been utilized to form a kinate of quinine, 
under the belief that a combination of quinine in its natural state would 
be more efficient as a remedy than as combined with a mineral acid. 

When the mother-liquor, left after the crystallization of the alka- 
loids, is evaporated, a black residue is obtained, which is called eliino- 
idln. This contains amorphous quinine and cinchonine, and probably 
also quinidine and cinehonidine, described on page 181. It was made 
official by the pharmacopoeia of 1880. It is an efficient antiperiodic. 

With regard to the quantity of the alkaloids contained in the barks, 
respectively, it may be stated that the three varieties — pale, yellow, 
and red — differ only in the relative proportions of their constituents. 
The pale bark contains most cinchonine, the yellow most quinine, and 
the red an equal proportion of each. 

Administration. — The alkaloids of bark are intensely bitter. 
Quinine being insoluble in the saliva, is less objectionable than its 
salts. The sweet principle of liquorice covers the taste of the cin- 
chona alkaloids. A sufficient dose of quinine may easily be inclosed in 
a chocolate caramel. The sugar-coated pill, when freshly prepared 
and by a reputable maker, is a convenient and suitable form for ad- 
ministration ; but by keeping it becomes hard and insoluble. The 
most active form is a solution, the quinine being dissolved by the 
aid of sufficient dilute acid. For hypodermatic use, the following 
formulae may be followed : I£ Quininae sulphat., 3 j ; morphinae 
sulph., gr. ss ; acid, sulphur, dil., tti xl ; aquae destil., 3 j. M. Fil- 
ter. Sig. : Sixty minims contain seven and a half grains. Lente's 
solution is the following : ~fy Quininae bisulph., grs. 1 ; acid, sulph. 
dil., vi c ; aquae font., § j ; acid, carbol. liq., ti[ v. Solve. The qui- 
nine is dissolved by the aid of heat, and after filtration the carbolic 
acid is added. 

Antagonists and Incompatibles. — Substances containing tannic 
acid in a free state should not be administered with the infusion or 
decoctum cinchonce. The preparations of iodine (tincture and com- 
pound solution) are also incompatible, for they form insoluble com- 
pounds with the cinchona alkaloids. The alkalies, alkaline carbonates, 
and alkaline earths, should not be administered with the solutions of 
the alkaloids, because the latter will be precipitated. 

As an agent promoting constructive metamorphosis, cinchona and 



CINCHONA. 183 

its alkaloids are therapeutically antagonized by mercury, the iodides, 
the salts of copper, zinc, and lead. 

As Gubler has shown, morphine and quinine are antagonists in re- 
spect to their effects on the brain. As regards their action on the 
sympathetic system, on the heart, and on the temperature, quinine, and 
belladonna and its alkaloid, are antagonistic. 

Synergists. — All those agents which promote constructive meta- 
morphosis, as the bitters, the ferruginous preparations, arsenic, and 
the acids, are synergistic to cinchona. 

Physiological Actions. — The preparations of cinchona are known 
as " astringent bitters " : they contain, in addition to bitter principles, 
two tannic acids. As bitters they act as stomachic tonics ; that is, 
promote appetite, the flow of gastric juice, and the digestive power. 
Long continued, as is the case with all the other bitters, they set up a 
gastric catarrh, and digestion becomes painful and labored. They 
differ from the simple bitters in exercising an astringent action on the 
intestinal mucous membrane, and cause constipation. The red bark 
is more decidedly astringent than the yellow or pale bark. 

Since the time of Sir John Pringle, who made the first experiments 
on this point, cinchona has been known to possess antiseptic properties. 
The powdered bark, applied to unhealthy wounds, arrests putrefactive 
decomposition, and promotes healing. The alkaloids are destructive 
of the minute organisms, on the presence of w T hich fermentative 
changes depend, and hence, when added to milk, urine, and other ani- 
mal fluids, will prevent decomposition (Binz, Herbst, Baxter, etc.). 
Quinine, the most active of the alkaloids, is not equally destructive of 
all minute organisms : some, it merely inhibits ; others, it kills. The 
bacteria of septic fluids resist its toxic action to a great extent, and 
are only inhibited by the largest quantity. 

When the crude bark is introduced into the stomach, the alkaloids 
are dissolved out by the acid gastric juice, in which they are freely 
soluble. Any portion of the bark, or of the alkaloids, escaping solu- 
tion in the gastric juice, probably, passes out with the other unabsorbed 
contents of the intestine. The alkaline reaction of the intestinal 
juices will cause precipitation of the alkaloids, which, forming insol- 
uble combinations with the bile-acids, will not be absorbed. From 
the stomach the alkaloids diffuse into the blood with facility. In the 
alkaline blood, it is probable that the alkaloids are held in solution by 
the carbonic acid (Kerner). No changes visible by the unassisted 
eye are discernible in the blood, for, notwithstanding the observations 
of the older writers, who affirm that the blood was dark and unco- 
agulable, the moderns deny the existence of such alterations (Briquet, 
Schwalbe). Quinine acts in a definite manner on certain constituents 
of the blood — on the haemoglobin, impairing its power to transport 
active oxygen or ozone, into which the ordinary oxygen of the air is 



184 RESTORATIVE AGENTS. 

converted. This is demonstrated in the following manner : Mix with 
old turpentine, that is, turpentine long exposed to the air, and there- 
fore holding ozone, some tincture of guaiacum ; if, now, some haemo- 
globin or a drop of blood be added to the mixture, the tincture of 
guaiacum assumes a blue color, the change of color being due to the 
oxidation of the guaiacum by the active oxygen or ozone contained in 
the haemoglobin (Hermann). The addition of certain substances, no- 
tably of quinine, prevents the reaction ; in other words, destroys the 
ozonizing action of the blood. Binz has shown that so small a quan- 
tity of quinine as one part to twenty thousand exerts this action to a 
considerable extent. As soon as the blood is withdrawn from the 
peculiar influence exerted by the walls of the blood-vessels, as was 
some time ago shown by Pfliiger and Zuntz, its alkalinity begins to 
decline, and presently it exhibits an acid reaction. Correspondingly 
with the progress of this acidification, A. Schmidt has shown that the 
quantity of contained oxygen diminishes and the carbonic acid in- 
creases. These changes, leading finally to the death of the blood, are 
greatly retarded by the addition of quinine (Schulte, Binz, Ransone, 
Kerner). From these observations we draw the conclusion that qui- 
nine lessens the oxidizing or ozonizing function of the blood. 

Binz and his pupils have shown that quinine inhibits or lessens the 
activity of the white blood-corpuscles, and indeed destroys them, or 
arrests their production ; for, in cats poisoned by this agent, the num- 
ber of white corpuscles was found to be considerably less than in un- 
poisoned animals (Scharrenbroich, Martin, Jerusalimsky, Geltowsky). 
By all the observers just named, by Baxter, who made a series of very 
carefully conducted experiments, and by Cutter, it has been estab- 
lished that quinine inhibits the amoeboid movements of the white cor- 
puscles. These bodies, as other masses of protoplasm, are in con- 
stant motion, changing their form and appropriating the materials 
of their nutrition. Such movements are called amoeboid, and they are 
arrested by quinine, even in so small a quantity as one part to four 
thousand ; hence it is called a protoplasmic poison. Quinine has also 
the power to prevent or arrest the migration of the white corpuscles 
from the vessels. This Binz was the first to demonstrate, using the 
method employed by Cohnheim for exhibiting the phenomena. This 
is now generally conceded, although denied by Schwalbe ; but, as the 
observations of Geltowsky show, the quantity of quinine necessary to 
produce the result varies with the animal experimented on, and ranges 
from one part in four thousand to one part in eight hundred, outside 
of the body (Appert). No amount, short of a fatal dose, can affect 
the movements of the white corpuscles in the living warm-blooded 
animal, according to Geltowsky, who, therefore, holds to the same view 
as Schwalbe on this point. In opposition to the views of Binz must also 
be placed Schtschepotjaw, who has studied the effects of small quantities. 



CINCHONA. 185 

Quinine also affects the rate of movement of the heart. An impor- 
tant distinction exists between the action of small and large doses. It 
is a matter of daily observation that ordinary medicinal doses of qui- 
nine (from two to five grains) increase the action of the heart, while 
experiments with large doses have demonstrated that this agent de- 
presses the circulation. Observations on the intra-cranial circulation, 
as seen through the retina and drum membrane, have demonstrated 
that an artificial hyperemia results from the administration of medi- 
cinal doses. On the other hand, as Favier was the first to observe, 
quinine in large doses depresses the heart, arrests it in the diastole 
without impairing its contractility, and lowers the arterial tension 
(Chirone, Briquet). Quinine acts on the cardiac motor ganglia, and 
hence occur the feebleness of the heart's movements and in part the gen- 
eral lowering of the vascular tension (Lewizky). Besides these effects, 
it unquestionably depresses the vaso-motor system, after a short pre- 
liminary stimulation, probably (Jerusalimsky, Lewizky, Briquet). This 
depression of the heart from large doses occurs after the vagi are 
divided (Briquet, Schlockow, Kohler, Lewizky), and is more conspicu- 
ous when the agent is introduced into the jugular vein, indicating that 
the impression made on the heart is not through an increase of inhibi- 
tion, but on the cardiac ganglia. Immersion of the heart in a quinine 
solution quickly arrests its movements. 

In the normal condition of the human subject, quinine does not 
appreciably affect the temperature. In the course of some carefully 
conducted experiments a few years ago, I found that the maximum 
doses caused not more than a half -degree decline in a healthy adult. 
In fever, however, the influence of antipyretic doses is prompt and 
decided. This result may be attributed to several factors : to the de- 
pression of the heart and arterial tension, to the suspension of the 
oxidizing power of the blood, and to the inhibition of the white cor- 
puscles. Jtirgensen was the first to observe that quinine prevented 
the rise of temperature produced by certain physiological acts, as, for 
example, active exercise, but Kerner has more particularly developed 
the experimental evidence proving this fact. By active gymnastics, 
the temperature was found to be elevated two to three degrees Centi- 
grade ; but the previous exhibition of a full dose of quinine prevented 
this rise of the body-heat. Kerner also ascertained that the increased 
cutaneous secretion, the result of active exercise, was prevented by 
the administration of sufficient quinine. From all of these facts, it 
seems evident that the lowering of the temperature by this agent de- 
pends on diminished production of heat rather than increased radia- 
tion and loss by cooling of the skin. This statement seems confirmed 
by the experiment of Lewizky, made in Hering's laboratory, by. wrap- 
ping a rabbit in protective envelopes to prevent loss of heat by cool- 
ing, and then practicing the intra-venous injection of quinine ; the re- 



1S6 RESTORATIVE AGENTS. 

suit was a depressioD of temperature as in animals not so enveloped. 
To such experiments, the author opposes the insuperable objection 
that the temperature in rabbits kept at rest declines, and to a remark- 
able extent, without the administration of any medicament. Never- 
theless, the fact of the reduction of temperature by quinine is un- 
doubted. By Popow, who admits the diminution of temperature, the 
influence of quinine over the body-heat is referred to some unknown 
biological process. 

In small doses quinine exerts a distinct stimulant effect on the 
cerebrum, increases the mental activity, and even exhilarates in some 
mobile constitutions. As some hyperemia is caused by it, the result- 
ing cerebral stimulation is probably secondary to this change in the 
vascular condition. In full medicinal doses, as the quinine accumu- 
lates in the brain, a sense of fullness in the head, constriction of the 
forehead, tinnitus aicrium, more or less giddiness, even decided ver- 
tigo, may be produced. Dullness of hearing results from considerable 
doses, and deafness has in rare cases been permanent. In a long ex- 
perience of its use and extended observation, no case has come under 
my notice of permanently impaired hearing, although the temporary 
condition is usual. According to Knapp, Moos, and others, amaurosis 
is produced by very large doses. White atrophy of the optic disks 
occurs, and most of the vessels disappear from the field. This must be 
due to strong contraction of the vessels, since this condition is quite 
curable, the ordinary appearance of the retina being restored in most 
of the cases. Permanent atrophy of the optic nerve is, however, an 
occasional result. Amblyopia is frequently produced by the use of 
considerable doses kept up for some time. It is recovered from readily 
by suspending the administration of the remedy and taking the neces- 
sary steps to improve the intraocular circulation. In actually toxic 
doses all of the above symptoms have been intensified. There are in- 
tense headache with constriction of the forehead, dimness of vision or 
complete blindness, deafness, delirium or coma, dilated pupils, weak, 
fluttering pulse, irregular and shallow respiration, convulsions, and 
finally collapse and death. It is excessively rare to encounter such 
severe cerebral symptoms. 

The influence of quinine over the functions of the spinal cord is 
yet subjudice. Chaperon some time ago demonstrated that quinine 
lessened and ultimately abolished the reflex function of the spinal 
cord. This result he decided was due not to immediate action on. the 
spinal cord, but to stimulation of Setschenow's center of inhibition of 
reflex movements. Brunton, who has repeated Chaperon's experi- 
ments, has found them to be correct. The observation of Schlockow, 
that the first effect of quinine is to increase the sensibility of the re- 
flex function of the spinal cord, has much probability in its favor. 
Heubach has also, after moderate doses, observed some evidences of 



CINCHONA. 187 

the existence of reflex irritability, but the experiments of Brunton 
show that these reflex effects decline with the increasing stimulation 
of the inhibiting center. Brunton's experiments were also directed 
to ascertain whether the sulphuric acid in combination with the qui- 
nine was responsible for the effects observed, but the result proved 
that quinine is the active agent in stimulating Setschenow's inhibiting 
center. 

As quinine depresses the functions of the sympathetic system, its 
action is opposed to that of agents which have the power to promote 
uterine contractions, hence, a priori, it would not seem to be aborti- 
facient. Very numerous and conflicting statements have been put 
forth, because there are no exact data. The few cases in which uter- 
ine action followed the administration of quinine were, doubtless, due 
to malarial intoxication or to other causes, and hence the association 
of uterine action with the effects of quinine was accidental. The in- 
numerable instances in which quinine has been given during the exist- 
ence of pregnancy, without initiating contractions of the womb, are 
certainly conclusive against the view of its abortifacient power. 
While it is not a special uterine stimulant, it may exert such an ac- 
tion indirectly. When uterine inertia is due to depression of the vital 
forces, quinine, in moderate doses, then becomes a valuable stimulant, 
and is utilized for this purpose in obstetric practice. 

The diffusibility of quinine and its rate and mode of elimination 
have been studied by Bence Jones, Ciotti and Albertoni, and Kerner. 
Jones in his researches availed himself of the fluorescent property of 
animal tissues, possessed also in a high degree by the alkaloids of cin- 
chona, especially quinine. To this substance, as it appears in animal 
tissues, Jones gave the name " animal chinoidin," but he was not aware 
that fluorescence is a property possessed by large numbers of animal 
and vegetable bodies. Nevertheless, he recognized the fact that the 
diffusibility of quinine could be estimated by the increase in the fluo- 
rescence of animal textures, and he thus ascertained that in a half- 
hour after the administration of quinine a positive gain in fluorescence 
of the crystalline lens is observed. It is probable that under some 
circumstances — a catarrhal state of the mucous membrane, for exam- 
ple — a portion of the quinine taken fails to be absorbed, and is conse- 
quently excreted by the intestines (Byasson). The effect of this 
agent on the secondary assimilation is involved in more or less doubt. 
Opposing opinions have arisen from the different points of view taken. 
In the normal condition quinine, in small quantity, stimulates the nu- 
trition, and increases the excretion of waste products — urea, uric acid, 
creatinin, extractives, etc. ; but, in considerable doses, the opposite 
condition obtains — the decrease in the quantity of uric acid -is espe- 
cially well marked (Ranke, Kerner) — and when administered in mala- 
rial fevers all the products of waste are greatly increased. The con- 



188 ' RESTORATIVE AGENTS. 

ditions attending the use of the remedy, therefore, influence the re- 
sult. Considerable doses in the normal state diminish the excretion 
of urea, uric acid, creatinin, and phosphoric and sulphuric acids 
(Kerner). Strassburg, however, failed to find any change in the car- 
bonic acid. According to the observations of Cutler and Bradford, 
quinine has an obvious effect on the globular richness of the blood, 
increasing the relative proportion of the white, and diminishing the 
red globules. The action of quinine on the spleen is still sub judice. 
Piorry was the first to note a reduction in the size of the organ pro- 
duced by quinine, but he had an exaggerated notion of the nicety by 
which a difference in the size of an organ could be made out by the ples- 
simeter and hammer. Kuchenmeister examined the subject experi- 
mentally in 1851, with negative results, but afterward, operating 
with larger doses, obtained confirmation of Piorry's view. Mosler, after 
dividing all the nerves of the spleen, ascertained that quinine in large 
doses still acted on the contractile elements, and reduced the size of 
the organ. Jerusalimsky, in an elaborate research, has established 
the same fact. That the enlarged spleen of malarial infection is re- 
duced by quinine is an undoubted clinical fact. From these positive 
observations it must be concluded that quinine does act on the spleen, 
notwithstanding there are numerous negative statements. It follows, 
hence, that the diminution in the red and increase of the white cor- 
puscles may be due to this action. 

Quinine diffuses out of the blood into the urine, chiefly, but also 
into the sweat, saliva, milk, and pathological exudations (Kerner, 
Briquet, Binz). Jtirgensen found quinine in the urine in ten minutes 
after the hypodermatic injection. Thau had evidence of its presence 
in the urine in a half -hour after the ingestion of a half -drachm dose 
each by two persons, and he holds that the maximum elimination takes 
place in about eight hours, but the excretion is not completed until 
two days after the administration. According to De Renzi, quinine 
remains in the organism a variable number of days, and may indeed 
be discovered in the urine on the third day ; in a special case, as late 
as seven days. Binz also finds that the elimination of quinine is vari- 
able and rather slow, the maximum being excreted within forty-eight 
hours. From the time the agent appears in the urine, the systemic 
action is manifest, and the maximum effect of any given dose must 
be experienced in advance of the period of maximum elimination, 
which Thau places at eight hours. According to Kerner, quinine ap- 
pears in the urine in a somewhat modified form. 

The action of quinine has occasionally been attended by the ap- 
pearance of an eruption on the skin. Sometimes the exanthem has 
been in the form of an erythema, sometimes it has assumed the ap- 
pearance of urticaria ; again, it has seemed to be herpetic. There is, 
in fact, no constant and invariable eruption, and many of the reported 



CINCHONA. 189 

cases are open to the suspicion that the appearances on the skin are 
merely accidental, and not causative. 

Therapy. — A solution of quinine will sometimes, when applied to 
the nares, arrest an attack of summer catarrh, a malady which appears 
to be produced by the pollen of plants. The preparation most suitable 
for this purpose is an aqueous solution of the hydrochlorate (gr. iv — 
gr. viij — § j). This should be applied by a large camel's-hair brush, 
or spray-producer, to the nares and fauces. The utility of quinine in 
this peculiar disease will be determined by the extent to which the 
local trouble has proceeded ; it can be useful only when the irritation 
is confined to the nares and fauces. 

The aphthous ulceration (inuguet) which succeeds to an exhausting 
entero-colitis, or which occurs in cachectic infants, is much improved by 
quinine — a grain or two every three hours. An attack of acute tonsillitis 
may sometimes be aborted by a full dose of quinine (ten to fifteen grains). 
This practice is especially indicated in those cases which proceed to 
suppuration, but the quinine must be administered before pus forms. 

The preparations of cinchona are much used as stomachic tonics. 
In atonic dyspepsia they are employed, like the simple bitters, to pro- 
mote the flow of gastric juice. In gastric catarrh they relieve that 
morbid state of the mucous membrane on which the increased produc- 
tion of mucus depends. For these purposes they may be combined 
with the mineral acids. The best preparation is the infusion ; the de- 
coction, although official, is inelegant and faulty. The alkaloid quinine 
is frequently used for the same purposes, and notably in the gastric 
catarrh of drunkards, combined with acids. When vomiting of yeast- 
like material is due to the presence of sarcina, quinine may be used 
in virtue of its power as a poison to these minute organisms, and as 
an anti-ferment. In these stomach-disorders other and less expensive 
drugs may be used with equal advantage. (See Hydrastis.) When 
there is a relaxed state of the gastro-intestinal mucous membrane, 
manifested by catarrh, diarrhoea, etc., but without inflammation, the 
preparations of red bark are more particularly indicated in virtue of 
the tannins which they contain. The reader need hardly be reminded 
that the preparations of cinchona are contraindicated in all inflam- 
matory states of the intestinal mucous membrane. Furthermore, if 
too long continued, they will set up an irritation, and perpetuate the 
troubles which they were prescribed to remove. 

Sometimes it happens that the entero-colitis of children (cholera 
infantum), which resists every possible combination of astringent and 
laxative, will yield readily to quinine. The author has seen quinine 
give prompt relief in the following : A child suffers with tenesmus, 
and after much straining voids a transparent mucus streaked with 
blood, but there is no fever nor other disturbance of the bowels, and 
the stools when passed are natural. 



190 RESTORATIVE AGENTS. 

The preparations of cinchona and quinine are very serviceable in 
that state of the mucous membrane which favors the development of 
ascarides. After the expulsion of the parasites, these remedies remove 
the saburral state of the mucous membrane. A combination of purga- 
tives and bitters will correct the following condition of things as they 
occur in children : A foul breath, coated tongue, capricious appetite, 
tumid belly, and constipation alternating with diarrhoea. 

The use of quinine as a restorative tonic in cases of debility is al- 
most universal. Given in moderate doses — six to twelve grains a day 
— it promotes constructive metamorphosis. Its utility is due not to 
any direct action on the blood, but to its stimulant effect on the 
digestive function, and the retardation of the combustion process. 
When cinchona or quinine proves irritant to the intestinal mucous 
membrane, this beneficial restorative action ceases. Iron and arsenic 
increase the power of quinine to promote construction of tissue and to 
retard waste. 

There can be no doubt in regard to the power of quinine to arrest 
the inflammatory process in its formative stages. Its utility, given 
with this view, ceases when the migration of the white corpuscles and 
the proliferation of the cellular elements of the inflamed parts have 
taken place, for it possesses no power to cause disintegration and ab= 
sorption of inflammation products. Administered at the critical mo- 
ment, a commencing fibrinous pneumonia, a pleuritis, an endocarditis, 
may be suppressed by a full dose (twenty to forty grains). Its power 
in this respect is much increased by combination with morphine. If the 
time have passed for the use of quinine in this way, it is employed with 
advantage as a restorative tonic in the various inflammatory affec- 
tions of low type, small doses (two to four grains) being given fre- 
quently. 

In septic diseases quinine has very important uses. Although the 
observations of Binz, showing the influence of quinine over septic pro- 
cesses, may not be applicable to the full extent for which he proposes 
them, there can be no doubt of the good effects in practice of quinine 
in septicaemia, pyczmia, erysipelas, and puerperal fever. In these dis- 
eases, only large doses — five to twenty grains — every four hours, are 
useful. 

The author's experience in the treatment of acute rheumatism does 
not justify the use of large doses of quinine, as now employed by Bri- 
quet and his followers in France. In the hyperpyrexia of acute rheu- 
matism, it is true, large doses of quinine will depress the temperature, 
but we have less distressing and more effective means for accomplish- 
ing this object in the wet-pack and the cold bath. When the acuter 
symptoms have subsided, and the skin is cool and perspiring, and the 
pulse weak, quinine in moderate doses — two to five grains — is very ser= 
viceable. 



CINCHONA. 191 

A careful examination of the large number of facts which have 
now been accumulated, and considerable personal experience and ob- 
servation, have satisfied the writer of the inutility of quinine as a 
means of aborting or shortening the duration of typhus and typhoid 
fevers. Not only has this remedy little or no influence over the 
course and duration of these affections, but its irritant effects upon 
the gastro-intestinal mucous membrane, and its inhibitive influence, 
exerted through the organic nervous system, upon the heart and lungs, 
may, in some cases, render it positively injurious in large doses. As 
a rule, the dryness of the tongue, the diarrhoea, the subsultus, and the 
delirium of typhoid fever, are increased by it. In certain parts of the 
United States, the prevalence of a mixed type — typho-malarial — re- 
quires, under certain conditions, the use of quinine in continued fevers. 
But it becomes less and less effective as the typh-element predominates. 
When there are evidently true remissions — and not merely the rhyth- 
mical morning remission and evening exacerbation characteristic of 
typhoid — quinine is indicated, and it is most effective when adminis- 
tered in an occasional large dose during the remission. When there 
is a condition of hyperpyrexia, or of continuously elevated tempera- 
ture, which endangers life by parenchymatous degeneration and car- 
diac or cerebral paralysis, quinine in antipyretic doses renders an 
incontestable service. This opinion of the author is fully confirmed 
by the committee of the Clinical Society of London, who find that 
large doses of quinine have a marked effect in reducing the temperature 
in pyrexia, and that, although, with the exception, perhaps, of certain 
cases of rheumatic fever in which the temperature is high, no decided 
evidence has been obtained to show that quinine has any influence in 
shortening the attack of a specific disease such as typhus or scarlet 
fever, yet from the marked effect on the temperature and pulse there 
is reason to believe that at the critical stage of acute disease, when 
pulse and temperature are high, a large dose of quinine may be em- 
ployed with benefit. Jiirgensen, Ringer, Liebermeister, and other 
authorities, and a vast clinical experience in all civilized countries, are 
now agreed in respect to the fever-reducing power of quinine and to 
the absence of ill results from large doses (especially Liebermeister). 
Liebermeister, indeed, says, if he were restricted in his choice to one 
antipyretic, he would select quinine. The quantity necessary to effect 
a decided reduction of the body-heat in fevers is determined by the 
age, the amount of disturbance, and the individual susceptibility to 
its action. In general, it may be stated that from twenty to sixty 
grains will be required. The antipyretic effect is more decided if it 
is given toward the close of the exacerbation or during the remission 
in typhoid or other fevers. The duration of the effect is " from one 
to forty-eight hours " ; consequently, a repetition of the dose will be 
necessary, if it is desired to maintain the reduction of the temperature. 



192 RESTORATIVE AGENTS. 

A few large doses at short intervals until the necessary quantity is 
reached, or a single maximum dose if the stomach is tolerant, should 
be prescribed, rather than a succession of smaller doses. The rapidity 
with which elimination takes place is a sufficient reason for adopting 
the former mode of administration. The effect of quinine is not less 
happy in the fevers of childhood, and comparatively large doses are 
well borne at this period, as Jacobi, especially, has shown us. The same 
rule should be followed as in the case of adults : to give the amount 
required in several doses within a brief period — an hour, according to 
Liebermeister — or at one time. The antipyretic use of quinine should 
not be confounded with its tonic or supporting qualities. In the treat- 
ment of fevers, the typhoid state, or the condition of adynamia super- 
vening during the course of fever, small doses (two, three, or four 
grains), at short intervals, are employed for the stimulating effects 
which they have on the organs of circulation, respiration, and diges- 
tion. Large doses, as has been set forth, depress these functions. 

In cerebrospinal meningitis, doubtless a continued fever with cere- 
brospinal lesions, quinine is indicated under the conditions already 
denned for the treatment of other inflammations, viz., in the begin- 
ning of the disease, when the alterations of cutaneous sensibility first 
occur, and before the febrile movement has developed. If a few large 
doses — twenty to thirty grains — do not produce a good result, it is 
useless to repeat them, or to pursue a tentative plan with small doses. 

In the treatment of the eruptive fevers, variola, scarlatina, rubeola, 
quinine has an important place. It is used in small doses, frequently 
repeated in adynamic states, and in large doses at longer intervals to 
reduce hyperpyrexia. In scarlet fever, Dr. Hood especially urges the 
use systematically of quinine from the earliest stage of the disease, 
preceded by an emetic and purgative, and he states as the result of 
this practice that since he has adopted it he has not lost a single case 
of this disease treated by him from the beginning. In measles, large 
doses of quinine have an unquestionable utility in relieving the ca- 
tarrhal pneumonia, and in preventing those changes in the exudation 
products which end in caseation. 

The treatment of malarial diseases by quinine is the most success- 
ful contribution ever made to practical therapeutics. No adequate 
explanation of its action had been offered before Binz suggested that 
its germicide power was the real source of its therapeutical activity. 
It was not, however, until Laveran discovered the flagellate organism 
and pigmented bodies which develop in the blood of those infected 
with malarial poison, that Binz's theory received support of a satis- 
factory kind. Laveran's discovery, made in 1881 in Algiers, has since 
been confirmed by Italian, French, and American pathologists, so that 
the long-sought cause of malarial infection may now be regarded as a 
known fact. The parasite consists of a pigmented body in the interior 



CINCHONA. 193 

of the red blood-corpuscles — pigmented granules of various shapes free, 
and flagellate organisms, both having amoeboid movements, the fila- 
ments of which engage in active vibration. 

The alkaloids of cinchona are employed as prophylactics against 
malarial infection. The experience of the English naval service, of 
crews engaged on the coast of Africa in the suppression of the slave- 
trade, of the expeditionary force into Ashantee under Lord Napier, and 
of our late civil war, has abundantly shown that quinine is in a high 
degree prophylactic. The first public reference to this property seems 
to be that of Dr. Bryon in 1854, who called attention to the success 
which attended its use among the crews of the British vessels serving 
on the coast of Africa. Since that time, for several years the statistical 
reports of the British naval medical service have contained conclusive 
evidence on this point. Dr. Joseph Jones has published since the close 
of the civil war some valuable statistical data, showing the efficiency 
of quinine as a prophylactic. The troops who were the subjects of ex- 
periment were stationed in a highly malarious locality. Of the num- 
ber, 230, who took no quinine, 134 had fever. Of those who took qui- 
nine irregularly, 246 in number, 96 had fever. Of the 506 who took 
quinine regularly, 98 had fever. The proportion of cases of fever was, 
therefore, 1 to 5*66 men. On the coast of Africa, the proportion has 
varied from 1 in 8 to 1 in 20. Of the unprotected, more than one half 
— on the coast of Africa, three fourths — were attacked by malarial 
disease in some form. As the quantity of quinine daily taken has 
been usually three to five grains, it is probable that the results would 
be even more favorable if a larger quantity of the prophylactic were 
given. When the poison is not intense, this amount may be sufficient, 
but if concentrated and active, and the conditions are otherwise un- 
favorable, twice as much should be administered daily. An enor- 
mous experience has now shown that quinine is entirely free from in- 
jurious effects when taken as a prophylactic. It is probable that the 
influence slowly decreases, and that some addition to the daily quantity 
may be necessary after a time. The prophylactic dose should be ad- 
ministered on rising in the morning, and may be usefully prescribed 
in a cup of black coffee, or in pill-form. The practice adopted in the 
civil war, of giving whisky as the vehicle, is not to be commended. 
If the quinine administered fail to prevent the disease, those attacked 
will suffer far less severely than the unprotected. Experience has 
shown that, to be entirely efficient, the quinine must be administered 
for some time, at least ten days, after exposure to the causes of fever 
(Jones). 

The mode of using quinine for the cure of intermittents may be 
formulated as follows : 

The antipyretic is nearly equally effective whether administered in 
the interval or during the seizure. 
14 



194 RESTORATIVE AGENTS. 

If time is an element of importance, no delay is necessary in order 
to give the remedy in the stage of apyrexia. 

To save the suffering and exhaustion of the febrile movement, the 
attack should be anticipated, and, if possible, prevented. 

As the maximum effect of the quinine is attained in about five 
hours after being taken, it should be administered this period of time, 
at least, before the expected paroxysm. 

As the elimination of quinine takes place with considerable rapid- 
ity, the maximum curative effect is obtained by the administration of 
the whole amount required in a single dose, rather than by a succes- 
sion of small doses (Prize Essay). 

An intermittent may be successfully treated by giving, during the 
interval, a number of small doses frequently repeated. The author is 
convinced by extended observation that a full dose of quinine (ten 
grains) in the sweating stage, and the same quantity five hours before 
the time of the next paroxysm, is the more effective method. The 
anti-periodic property of quinine is increased, and the cerebral effects 
of large doses diminished, by combination with morphine. It is well 
known that intermittents, arrested by quinine or other anti-periodics, 
manifest a tendency to recur about the septenary periods ; therefore, 
ten to fifteen grains of quinine should be administered in anticipation of 
these recurrent paroxysms, until the third septenary period has passed. 
Meanwhile, the organs damaged by the malarial infection — intestinal 
canal, liver, spleen, kidneys, etc. — require appropriate treatment. The 
action of quinine is much assisted by the continuous administration of 
arsenic during the intermissions, and until the third septenary period 
has passed. The unpleasant cerebral effects of quinine are lessened or 
prevented by the simultaneous administration of diluted hydrobromic 
acid : ^ Quininse sulph., 3 j ; acid, hydrobromic. dil., 3 ij ; aquae, 
3 xiv. M. Sig. : One or two teaspoonfuls at a dose. 

In the treatment of remittent fever two modes of using quinine are 
employed : first, by emetics, purgatives, baths, diaphoretics, etc., to 
secure a distinct remission when the remedy is administered ; second, 
to give it in sufficient dose immediately, relying on its apyretic effect. 
The author is convinced that the latter plan is preferable : from twenty 
to thirty grains in a single dose once or twice each day until the tem- 
perature is reduced to normal. This use of the remedy need not inter- 
fere with other appropriate medication. 

In the so-called pernicious fever ', it is agreed on all hands that the 
safety of the patient is secured only by the prompt use of large doses 
(twenty to sixty grains), and administration by the stomach, rectum, 
and skin may be in turn or simultaneously resorted to. 

In chronic malarial infection, important changes have been pro- 
duced in the intestinal canal, liver, spleen, kidneys, cerebro-spinal axis; 
the paroxysms of fever occur irregularly ; various abnormal manif es- 



CINCHONA. 195 

tations of the infection take place (dumb ague, enlarged spleen, etc.). 
Under these circumstances, quinine is less curative than when the infec- 
tion is recent, and the paroxysms will recur from time to time notwith- 
standing its use, unless these structural alterations are corrected. In 
chronic malarial disease, salicylate of quinine and salicylate of cinch o- 
nidine are especially effective. 3 Cinchonidinae salicylat., 3 ij ; acidi 
arseniosi, gr. j ; ferri sulph. exsic, 3 j. M. Ft. pulv. (wafers) no. xx. 
Sig. : One three times a day. Also: fy Chinoidin., 3 ij; quininge salicy- 
lat., 3 j; ferri sulph. exsic, 3j. M. Ft. pil. no. lxxx. Sig.: Two pills 
three times a day. $ Quininse sulph., chinoidinse, aa 3 j ; res. podo- 
phylli, gr. v; ferri sulph. exsic, 3 ss. M. Ft. pil. no. lx. Sig.: Two 
pills three times a day. 

In periodical affections of malarial origin, quinine is equally as ef- 
fective as in the periodical febrile diseases, but somewhat larger doses 
are necessary. A difficulty of diagnosis often arises in these diseases, 
for the reason that the neuroses are irregularly periodical in their 
manifestations, when not malarial in origin. The existence of a ma- 
larial cachexia, and the more uniform periodicity in the recurrence of 
the paroxysms, will enable the practitioner to distinguish the neuroses 
of malarial origin from the other functional disorders of the nervous 
system. The following group contains the disorders of the sensory 
nervous system caused by malaria : tic-douloureux, cephalalgia, cer- 
vico-brachial neuralgia, cervico- occipital neuralgia, dorso-intercostal 
neuralgia, lumbo-abdominal neuralgia, mammary neuralgia, crural neu- 
ralgia, gastralgia, enteralgia, hepatalgia, nephralgia, hysteralgia, ova- 
ralgia, sciatica, angina pectoris. The following motor disorders, also, 
are produced by malarial influences : epilepsy, chorea, stricture of 
urethra, hiccough, laryngismus stridulus, asthma, summer catarrh. 
These neuroses may occur as an expression of malarial infection, 
being substituted for the ordinary chill, fever, and sweat, or they may 
assume the orderly periodical character in consequence of having 
occurred in an organism already under the influence of the malarial 
cachexia. If they are of malarial origin, the specific action of quinine 
will speedily prevail against them. These malarial neuroses require 
large doses of quinine, and the same fact is true of all irregular mani- 
festations of malarial infection. Ten to twenty grains, according to 
the severity of the attacks and the obstinacy with which they recur, 
are necessary, and the paroxysms should be anticipated by the exhi- 
bition of the remedy from three to five hours before the expected time. 
In cases of malarial neuralgia, the curative effect of quinine is enhanced 
by combination with morphine, either in the same prescription or by 
simultaneous administration of the latter subcutaneously. 

Diarrhoea, dysentery ', jaundice, and hypertrophy of the spleen oc- 
casionally occur in the periodical form, or are due to the immediate 
influence of paludal miasm. Under these circumstances quinine af- 



196 RESTORATIVE AGENTS. 

fords relief without the use of any other remedy. Very frequently the 
diarrhoea, dysentery, and jaundice are results of structural alterations 
in the liver and the glandular apparatus of the intestine, and are not 
merely functional disorders which quinine may remove. In malarial 
enlargement of the spleen, quinine is supposed to be especially effec- 
tive ; but quinine exhibits a curative power only in cases of simple 
enlargement, and does not affect that condition known as "fleshy 
spleen," or chronic splenitis, of inflammatory origin. 

Hematuria, when distinctly intermittent and arising from malarial 
infection, is cured by quinine, but large doses are necessary. Accord- 
ing to Karamitsas, sometimes hematuria is caused by this agent. 

Cases of cerebral disease, occurring in weak and anaemic subjects, 
are sometimes much improved by small doses of quinine. The author 
has observed great relief by the use of this remedy in the following 
group of symptoms, occurring in men advanced in life : Headache, 
vertigo, failure of memory, and despondency, associated with a slow 
pulse, an atheromatous degeneration of the vessels, puffiness of the 
eyelids, and dilatation of the superficial veins of the head. From 
three to ten grains daily may be given with advantage, the effect being 
to remove that sluggishness of the intra-cranial circulation on which 
these symptoms depend. In insanity, especially the puerperal form, 
when there is much weakness, and the skin is cold and sweating, qui- 
nine is very useful. When there is a condition of adynamia — the usual 
state — in delirium tremens, small doses of quinine assist materially in 
tranquillizing the patient. In that preliminary stage known as "hor- 
rors," characterized by restlessness, tremor, nausea, and anorexia, qui- 
nine, with a mineral acid, renders important service by restoring the 
digestive function, and by giving steadiness to the cerebral motor 
centers. 

Although headache (hemicrania) and neuralgia of malarial origin 
are cured by quinine, by no means equally successful results follow 
the use of this remedy in ordinary headache and neuralgia. Quinine 
is largely employed, it is true, in these affections when not caused by 
malaria, but it is useful only when anaemia is present and is causative. 
The same remark is true of epilepsy and chorea. 

An attack of acute catarrh may often be entirely aborted by a 
full dose (ten grains) of quinine and morphine (one half a grain), if 
given at the incipiency of the attack. After the acute symptoms have 
subsided, quinine is very serviceable in hay-asthma. Diphtheria being 
an adynamic disease, quinine is used by the stomach with a view to 
its restorative action, and in the form of spray to arrest the spread of 
the exudation in the fauces. The power of quinine to kill bacteria 
and micrococci renders its local use a rational measure in a disease 
characterized by an enormous multiplication and diffusion of micro- 
cocci. 



CINCHONA. 197 

Laryngismus stridulus, a reflex spasm of the muscles of the larynx 
occurring in rickety, ill-fed, and ansemic children, may be prevented 
recurring by the use of quinine in the intervals between the attacks. 
Quinine is one of the remedies which is used in membranous croup, 
but the reported successes were probably cases of spasmodic croup. 
There can be no doubt regarding the good effects of quinine in asth- 
ma, after the severity of the paroxysms has somewhat abated, as an 
apyretic in the fever which succeeds, and as a restorative tonic. It is 
also the most useful tonic which can be employed in chronic bron- 
chitis, with profuse expectoration (bronchiectasis). The hectic fever 
and sweats of phthisis are prevented by large doses (fifteen to twenty 
grains) of quinine, but this remedy really has no influence over the 
course and progress of the disease. 

In skin-diseases, when there is present a lowered condition of the 
vital forces, quinine is indicated. It is the most valuable remedy in 
erysipelas and erythema nodosum. It is a curious fact that in many 
subjects a full dose of quinine will cause an erythema, with dilated 
pupils, phenomena closely analogous to those produced by belladonna. 
Ecthyma and impetigo, usually arising in a feeble state of the assimi- 
lative functions, are cured by quinine. 

Quinine is largely employed in surgical affections, to sustain the 
powers of life during protracted suppuration, and to check the forma- 
tion of pus. It is the most generally prescribed remedy for surgical 
fever. A full dose of quinine, given before the operation, may pre- 
vent the chill and fever which succeed in some subjects to the opera- 
tion of catheterization. 

Subcutaneous and Local Uses of Quinine. — The increasing use 
of quinine hypoderinatically requires further consideration of this sub- 
ject. In pernicious intermittent^ and remittents, when life is put in 
imminent danger, the most speedy and effectual way of introducing 
the remedy must be employed. Besides the hazards due to the inten- 
sity of the poison, an irritable stomach and rectum prevent the intro- 
duction of the remedy by either of those channels. The subcutaneous 
method then becomes most important. Again, in obstinate and re- 
peatedly relapsing intermittents, the introduction of the remedy by 
the skin imparts to it greater curative power. In enlarged spleen 
(ague-cake), malarial jaundice, with great irritability of the stomach, 
and a catarrhal state of the gastro-intestinal mucous membrane, the 
subcutaneous method becomes necessary, or, if not essential, is much 
more effective. Quinine and the sulphate simply suspended are not 
adapted to subcutaneous use. Several cases of tetanus have been 
reported from New Orleans (Sale), and two cases occurred in one 
regiment of the British Indian Army from their use in this way. 
The salt employed for hypodermatic use should be sufficiently solu- 
ble that no undissolved particles be thrown under the skin. Various 



198 RESTORATIVE AGENTS. 

solutions have been proposed. The muriate is more soluble than the 
sulphate — dissolves in twenty-four parts of cold water, and about 
three parts of alcohol. One grain will dissolve in about fifteen min- 
ims of hot water, and in a much less quantity of alcohol-and-water, 
but alcohol is irritating. Lente's solution, which is much employed 
in New York, is prepared as follows : ££ Quininse disulph., grs. 1 ; 
acid, sulphuric, dil., tti c ; aquae font., § j ; acid, carbolic, liq., in, v. 
Solve. This contains six grains to the drachm. Dr. Lente directs that 
the quinine and water be heated to the boiling-point when the acid is 
added. The solution is then filtered into a bottle and the carbolic acid 
added. Below 50° Fahr. it must be warmed before using. A solution 
of kinate of quinine is much used at Guy's Hospital at the strength 
of one to four. The kinate is obtained by decomposing sulphate of 
quinine with the kinate of barium. The mode of preparing the solu- 
tion is as follows : Put into a beaker 3 vj of distilled water and 3 ij of 
kinate of quinine, and heat until the salt dissolves, which it does al- 
most immediately, and then add enough distilled water to make up to 
§ j. The disadvantage of so concentrated a solution is the incrusta- 
tion, by evaporation, of the bottle and syringe with the solid kinate. 
The sulpho-vinate of quinine is very soluble — one part in three of 
water at 60° Fahr. — and is readily prepared by double decomposition 
between the alcoholic solutions of sulpho-vinate of sodium and sul- 
phate of quinine. Gubler advocates the hydrobromate, as follows : 
I> Quininse hydrobromat., grs. xlviij ; aqua? destil., 3 iv. M. Dis- 
solve by heat if necessary. Five minims contain one grain. 

Recently a new compound salt of urea and quinine has been pro- 
posed, and it seems to possess distinct advantages over every other 
preparation : it is designated quinia bimuriatica carbamidata, and is 
formed by Drygin from a combination of twenty parts of muriate of 
quinine, twelve parts of muriatic acid, and three parts of urea. The 
resulting salt is soluble in equal parts of water. The utility of this 
compound is not entirely theoretical. Practical trials made at Ham- 
burg have demonstrated its fitness for hypodermatic use. A fifty-per- 
cent solution has usually been employed, and a half to three syringefuls 
(fTi xv to 3 jss) injected. The local irritation is represented as slight. 
Very favorable reports have been published in respect to the utility of 
the hydrobromate brought forward by Gubler. In the hands of Ray- 
mond, Soulez, and others, intermittents are said to have ceased after 
two injections of three grains each of this salt. The usual method 
pursued was to inject one and a half grain of the hydrobromate twice 
morning and evening, and, although six to twelve grains were usually 
successful, in one case thirty grains were required. It has also been 
employed in the treatment of acute rheumatism. 

Quinine in solution is applied in various affections of the fauces by 
atomization. In diphtheria especially have good results been produced. 



CINCHONA. 199 

A saturated solution of the muriate or of the bromide may be thus 
employed. There can be no doubt that a solution of quinine ap- 
plied to the nares may be very beneficial at the onset of hay '-asthma , 
as first shown by Helmholtz. The author has seen several cases 
benefited greatly ; but to achieve success the applications must be 
thorough and timely. The secret of any good effects it has, is 
afforded by its toxic action on germs, and possibly on the pollen of 
certain grasses, to the presence of which the irritation of the air- 
passages is ascribed. 

The author is indebted to Dr. W. R. Gray, of Orange, New Jersey, 
for a private communication in which he states that he has successfully 
used quinine by inunction — 3 j of quinine to 1 j of lard — in the case 
of children especially. The ointment should be thoroughly rubbed in 
over the abdomen and at the flexures of the joints. 

Authorities referred to : 

Appert, Dr. J. Virchow* s Archiv, Band lxxi, p. 364. Der Einfiuss des Chinin auf 
die Auswanderung der weissen Blutkorper bei der Entzundung. 

Bartholow, Dr. R. Russell Prize Essay — On Quinine, Hartford, 1868. 

Baxter, Dr. E. Buchanan. The Practitioner, London, November, 1873. The Action 
of the Cinchona Alkaloids on Bacteria, etc. 

Binz, Prop. Dr. Carl. Papers on the Actions of Quinine in Virchow' s Archiv, Band 
xlvi, pp. 67 and 129 ; in the Berl. klin. Wochen., No. 46, p. 556, and Nos. 47, p. 564, and 
48, p. 575, 1871 ; and in Archiv fur experimented Pathol, und Pharmacol., vol. i, p. 18, 
and vol. vii, p. 275. 

Briquet, Dr. Traite Therap. du Quinquina, Paris, 1855 ; and Bull. Gen. de Therap., 
vol. lxxxiii, p. 289. 

Brunton, Dr. T. Lauder. St. Bartholomew's Hospital Reports, vol. xii. On the In- 
fluence of Quinine on the Reflex Functions. 

Byasson, Dr. H. Journal de Therapeutique, vol. xiv, p. 526, 1880. Etude sur V elimi- 
nation par les urines des quatre alcaloides principaux de quinquina, ingeres d Vetat de sul- 
phates basiques. 

Chirone, Dr. Vincent. Gazette Hebdomadaire, 1875. Mechanisme de V action de la 
quinine sur la circulation. 

Ciotto and Albertoni. Bull. Gen. de Therap., May 15, p. 430, and August 30, p. 360, 
for 1876. Sur les voies d 'elimination et d' action elective de la quinine. 

Colin, Dr. Leon. Bull. Gen. de Therap., July 15 and 30, 1872. Etude sur les sels 
de quinine, de leur action physiologiques et medicate. 

Councilman and Abbot, Drs. The American Journal of the Medical Sciences, April, 
1885. 

Cutter and Bradford. The American Journal of the Medical Sciences, October, 1878, 
p. 367. 

Geltowsky, Dr. The Practitioner, June, 1872. On the Action of Quinine on the Col- 
orless Blood- Corpuscles. 

Herbst, Dr. H. Diss. Bonn. Virchow und Hirsch's Jahresbericht. Beitrage zur Kennt- 
niss der antiseptischen Eigenschaften des Chinins. 

Heubach, Dr. Central, fur die med. Wissensch., 43, 673, Virchow und Hirsch's Jahres- 
bericht, vol. i, 1874. Also, Archiv fur experimented Pathol, und Pharmacol, vol. v. 
Einwirkung des Chinins auf das Nervensystem. 

Jerusalimsky, Dr. Nic. Ueber die physiologische Wirkung des Chinins, Berlin, 1875, 
p. 89, pamphlet. 



200 AGENTS INCREASING WASTE. 

Karamitsas, Georges. Bull. Gen. de TJierap., August 15 and 30, 1880. Sur Vhcema- 
t uric provoquee par le quinine. 

Kbrnkr, Dr. G. Archivf. d ges. Physioloffie, etc., Band vii, p. 122. Ueber den Ein- 
fuss des kristallischcn und dcs amorphcn Chinins auf die weissen Blutkbrperchen. Also,. 
Beiircige zur Kenntniss dcr Chininresorption. Ibid., 1870, p. 366. 

Kohler, Dr. H. Quoted by Virchow und Hirsc/i's Jahresbericht for 1876, vol. i. Ueber 
die Wirkungen des Chinin. 

Layer ax, Dr. Trait'e des Fievres Palustrcs, etc. Paris, 1884. 

Lewizhy, Dr. P. Virchow's Archiv, Band xlviii, p. 352. Ueber den Einjluss des 
Schwefelsauren Chinins auf die Temper atur und Blutcirculation. 

Liebermeister, Dr. C. Archiv fur klin. Med., iii, pp. 21, 569. Ueber die antipyre- 
tische Wirkung des Chinins. Also, Handbnch der Path, und Therap. des Fiebers, p. 654. 

Martin, Dr. Adolph. Das Chinin ah Antiphlogisticum, Giessen, 1868. 

Osler, Prof. William. Pamphlet. An Address on the Hazrnatozoa of Malaria. 

Pantelejeff, Dr. S. London Medical Record, October 15, 1880. On the Antagonism 
of Quinia and Morphia. 

Papow, Dr. Virchow und HirscKs Jahresbericht, 1876, vol. i. Kritische und experi- 
mentelle Untersuchungen zur TJieorie der temperaturherabsetzenden Wirkung des Chinins. 

Ransone, Dr. R. Ueber einige Beziehungen des Chinin zum Blute, 1871. Diss. Bonn. 

Renzi, Dr. Bull. Gen. de Therapeutique, vol. xci, p. 45. Observations sur Velimina- 
tion du sulfate de quinine par V urine. 

Ringer, Dr. Sydney. Various papers in the London Lancet, British Medical, and Jour- 
nal of Physiology. 

Scharrenbroich, Dr. C. Berliner klinische Wochenschrift, 16, 1872, p. 190. Das 
Chinin als Antiphlogisticum. 

Schroff, C. v. J. Medz. Jahrb. ; Virchow und Hirsctts Bcitrdge zur Kenntniss der Chi- 
ninwirkung. 

Schulte, Dr. A. Diss. Berolini, Virchow und Hirscli's Jahresbericht, vol. i, 1871, 
p. 349. 

Schwalbe, Dr. C. Deutsche Klinik, 36, 325, 1868. Ueber die Entzundungswidrige 
Wirkung des Chinin. 



AGENTS PROMOTING DESTRUCTIVE 3IETAM0R- 
PHOSIS OR INCREASING WASTE. 

ALKALIES. 

Potassium. — Preparations: Potassa. — Potassa ; potasse, Fr. ; Kali 
hydricum, Ger. Caustic potash. Occurs in cylindrical rods, is very 
deliquescent, and dissolves in water and in alcohol. 
. Potassa cum Cake. — Equal parts of potassa and lime. Escharotic. 

Potassii Acetas. — Acetate of potassium. A white deliquescent salt, 
wholly soluble in water (100 in 35) and in alcohol (proof spirit 1 in 2). 
Dose, grs. v — 3j. 

Potassii Bicarbonas. — Bicarbonate of potassium. In white crys- 
tals, permanent in the air, wholly soluble in water (1 in 3), and having 
a slightly alkaline taste. Dose, grs. v — 3j. 

Potassii Carbonas. — Carbonate of potassium. A deliquescent salt, 
wholly soluble in water (100 in 75). Dose, grs. ij— grs. x. 



ALKALIES. 201 

Liquor Potassii Citratis. — Solution of citrate of potassium. Dose, 

3j-?j. 

Potassii Citras. — Citrate of potassium. A whitish, granular, deli- 
quescent salt, wholly soluble in water (10 in 6). Dose, grs. v — 3 ss. 

Potassii Tartras. — Tartrate of potassium. In white crystals, which 
are somewhat deliquescent, and are wholly and readily soluble in four 
parts of boiling water. Dose, grs. v — 3]. 

Potassii et Sodii Tartras. — Tartrate of potassium and sodium — 
Rochelle salt. In colorless, transparent crystals, which effloresce 
slightly in dry air, and are wholly and readily soluble in five times 
their weight of boiling water. Soluble in cold water, 1 in 2. 

Liquor Potassce. — Solution of potassa. A colorless liquid, having 
an extremely acrid taste, and a strong alkaline reaction. Dose, ttj, ij 
— Til xx. It should be taken well diluted with water. 

Potassii Chloras. — Chlorate of potassium. In colorless, tabular 
crystals, which have a pearly luster, and are wholly soluble in distilled 
water (in cold water, 1 in 16*5 ; in boiling water, 1 in 2). Dose, grs. 
v — 15 grs. 

Trochisci Potassii Chloratis. — Chlorate of potash troches. 

Potassii JVitras. — Nitrate of potassium. In colorless, prismatic 
crystals, unalterable in the air, and wholly soluble in water (in cold 
water, 1 in 4 ; in boiling water, 1 in 2J). Dose, grs. ij — grs. x. 

Potassii JBichromas. — Bichromate of potassium. In orange-red, 
anhydrous, tabular crystals, soluble in ten parts of cold, and in much 
less of boiling water, forming a solution having an acid reaction. 
Dose, gr. \ — gr. ss. 

Potassii Bitartras. — Bitartrate of potassium ; cream of tartar. 
Is sparingly dissolved in cold water (1 in 210), more freely in boiling 
water (1 in 15). Dose, 3 j — § ss. 

Potash salts not included in this list are considered elsewhere, in 
accordance with their physiological relations. 

Antagonists and Incompatibles. — The alkalies and their carbon- 
ates are incompatible with the acids and with metallic salts. The 
caustic alkalies decompose the alkaloids of belladonna, stramonium, 
hyoscyamus, duboisia, etc. In case of poisoning, the antidotes to be 
employed are — acetic, citric, or tartaric acids, in the form of vinegar, 
cider, lemon -juice, etc. 

Synergists. — The alkalies assist each other's action. All agents 
promoting waste — for example, mercury, the iodides, etc. — increase 
the therapeutical activity of the alkalies. 

Physiological Action of the Potash Salts. — The most recent 
experiments having shown that potash has quite distinct properties 
from the other alkalies of the group, each member of the group is con- 
sidered separately. As an alkali, potash combines with acids to form 
salts, and with fats to form soaps. As it has a great affinity for moist- 



202 AGENTS INCREASING WASTE. 

lire, and dissolves albumen, and is a very diffusible substance, it exerts 
a destructive action on the animal tissues. These chemical facts ex- 
plain the active caustic properties of potassa f usa. In the stomach the 
salts of potash obey chemical laws, neutralize the free acid, and sapon- 
ify oily or fatty matters. Given when the stomach is empty, potash, 
as do the alkalies in general, promotes the acidity of the gastric juice, 
by increasing the diffusion of those constituents of the blood from 
which the acid of the stomach is elaborated ; but, as a large amount 
of alkali will neutralize a corresponding proportion of acid, it is obvi- 
ous that, to obtain an increased quantity of acid gastric juice, the 
amount of alkali administered must be small and rightly timed. 

When a toxic dose of potassa, of the carbonate, nitrate, or chlorate, 
is taken, violent local inflammation results. The action and the ap- 
pearances are somewhat different as regards potassa and its salts. 
The former liquefies the tissues, and extends its escharotic action 
widely and deeply, the sloughs being surrounded by a zone of inflam- 
mation. The salts, according to their activity and the quantity taken, 
set up a high degree of inflammation, cause intense burning pain about 
the epigastrium, nausea, vomiting, sometimes of bloody mucus, purg- 
ing, the stools being watery and profuse, or they may be dysenteric. 
In the case of caustic potash, marks of corrosive action, sloughs of the 
mucous membrane, bloody oozing, may be seen about the lips, mouth, 
and fauces, and shreds of bloody and sloughing tissues vomited. In 
case of toxic action of potassa and its salts, the local destruction, pain, 
and inflammation are accompanied by the usual systemic symptoms — 
great depression of the powers of life, a weak, rapid pulse, shrunken 
countenance, cold surface, followed by coma and insensibility. In a 
small proportion of cases the local mischief is not great, but the effects 
of the poison are expended on the nervous system, and assume the 
form of muscular weakness, paralysis of the inferior extremities, weak 
action of the heart, and coma, and a very large dose may cause death 
suddenly by paralysis of the heart before the local inflammation has 
time to develop. The nitrate and chlorate are the most active of the 
salts, but all potash bases have more or less power in the same direc- 
tion. The well-known case of Dr. Fountain, of Iowa, illustrates some 
points in the action of chlorate of potassa. Entertaining some theo- 
retical notion of the curative power of this remedy when administered 
in considerable doses, he took an ounce to demonstrate its innocuous- 
ness. Violent gastro-enteritis was produced ; at first there was free 
diuresis, but urinary suppression followed, and death ensued in seven 
days after the ingestion of the poison. When recovery takes place 
after poisoning by caustic potash, deformity of the mouth, stenoses of 
the oesophagus, cardia and pylorus, may remain, and then, after a par- 
tial improvement, the mechanical interference with the functions of 
these organs causes a more or less rapid marasmus. 



ALKALIES. 203 

When the alkaline bicarbonates are taken on an empty stomach 
they diffuse quickly into the blood, where, meeting the neutral phos- 
phate of sodium, they are decomposed, acid phosphate of sodium being 
formed, and this compound, diffusing out of the blood into the urine, 
increases the acidity of that excretion (Rolfe). The result is different 
when bicarbonate of potassium is taken during digestion, for then, the 
reaction of the gastric juice being strongly acid, this salt is decomposed, 
carbonic acid is given off, and the alkaline base lessens the acidity of 
the stomach, increases the alkalinity of the blood, and diminishes the 
acidity of the urine. The salts of potash formed with vegetable acids 
undergo conversion into alkaline carbonates in their passage through 
the organism, and are eliminated in this form, thus causing an alkaline 
condition of the urine. The period of administration unquestionably 
influences the result to a large degree, as has just been stated. The 
increased alkalinity of the blood, produced by the administration of 
the potash salts, promotes its oxidizing function (Buchheim, Basham, 
Kohler, and others). The relative quantity of uric acid is diminished, 
and of urea increased. Basham, instructed by the observations of 
Schunck, that oxalurate of ammonia is a product of the oxidation of 
uric acid, and that the former is readily converted into urea and oxalic 
acid, holds that the same process takes place in the organism when 
uric acid is subjected to the action of the potash salts. The urine of 
patients suffering from uric-acid deposits was carefully examined 
after a course of the citrate or carbonate of potassium, and it was 
found, after an interval of about three days, that the urea was in one 
case trebled in amount, and in others more than doubled, while the uric 
acid was reduced to a fractional part of what had existed (Basham). 
The facts, then, are conclusive in regard to the increase in the oxida- 
tion processes, caused by the administration of potash, and its salts 
formed by combination with carbonic and the vegetable acids. The 
changes in the fatty constituents of the blood consist, probably, in a 
process of saponification and excretion. Nitrate and chlorate of po- 
tassium produce very different effects on the blood. Not parting with 
their oxygen in the system, and excreted undecomposed, the effects 
noted in the blood must be due to their action as a whole. The 
changes made by the chlorate in the composition of the blood have 
been studied recently by Marchand, in cases of poisoning in man and 
by experiments on animals. The blood assumes a dark, brownish, or 
chocolate color, and can no longer take up oxygen ; the haemoglobin 
is decomposed, and the injured blood-corpuscles accumulate in the 
spleen ; the kidneys are brownish in color, and the tubules are choked 
with the broken-down materials of the red globules. The peculiar 
brownish color of the blood is found, by spectroscopic analysis, to 
be due to a substance identical with Hoppe-Seyler's methaemoglobin. 
These effects separate the chlorate, nitrate, and other compounds of 



-204: AGEXTS INCREASING WASTE. 

potassa very distinctly from the compounds with vegetable acids, 
while the latter also differ distinctly from the former in the power to 
alkalinize the blood and urine. 

A very considerable reduction of temperature is produced by large 
doses of the potash salts (Poclcopaew, Guttmann, Traube). This effect, 
due especially to chlorate and nitrate of potassium, may be readily ex- 
plained by the changes in the haemoglobin, which impair its function 
as a carrier of oxygen. Ordinary doses do not affect temperature de- 
cidedly, probably because they do not have the power to change the 
properties of haemoglobin. The alterations produced in the composi- 
tion of the blood by the salts of potash necessarily affect the nutritive 
functions. The increased elimination of urea, the waste of the fatty 
constituents of the blood and of the tissues, the more rapid process of 
oxidation, results of the action of the potash salts, necessarily place 
these remedies among the list of those promoting destructive meta- 
morphosis. 

Drs. Ringer and Murrell find chloride of potassium to be a proto- 
plasmic poison, and to this effect they refer its action on the brain and 
nervous system and on the heart. That potash is a poison to the heart 
has long been known. The experiments of Podcopaew, repeated sub- 
sequently by Guttmann, confirm this. Whether introduced directly 
into the circulation, by injection into the jugular vein or subcutane- 
ously, the paralysis of the heart follows — more speedily, when the 
poison reaches the heart more directly. The arrest of the heart takes 
pLace in the diastole, and occurs after division of the pneumogastric, 
whence it must be concluded that the effect on the heart is not exerted 
through increase of the inhibition. As, when a large dose is suddenly 
precipitated on the heart, its movements are speedily arrested, and the 
muscle of the heart does not then respond to electrical excitation, the 
effects of the poison must be expended chiefly on the muscular tissue 
(Traube), but not wholly so, since, before the electro-contractility is 
entirely abolished, all motion may be arrested. The cardiac ganglia 
must therefore participate in the changes wrought by the poison. The 
effect, of potash on the tension of the vessels — on the blood-pressure — 
is much influenced by the quantity and mode of administration. A 
large quantity by intra-venous injection quickly poisons the heart and 
lowers the pressure in the arterial system. On the other hand, small 
doses increase the tension (Hummel, Traube). As elimination takes 
place very rapidly, it is not surprising to find that the normal pressure 
is quickly restored. This difference in the result, due to the size of 
the dose, is largely responsible for the conflicting statements which 
have been put forward. 

It has been ascertained by Ringer and Murrell, and by Guttmann, 
that the contractility of the muscles and the irritability of the motor 
nerves persist after complete paralysis induced by the potash salts. 



ALKALIES. 205 

The paralyzing action must, therefore, be exerted on the spinal cord. 
In fact, as Ringer and Murrell have shown, potash, being a protoplas- 
mic poison, affects most injuriously the most highly specialized struct- 
ures ; hence the brain and spinal cord suffer earlier and more severely 
than do other tissues. We owe to Dr. Ringer some important discov- 
eries as to the action of the alkalies on the frog's heart. As these 
observations are confirmed for the most part by clinical and experi- 
mental studies in man, they may be accepted as a close approximation 
to the actual facts. Potash, soda, and ammonia, in small quantity, 
increase the tonicity of the muscular walls of the heart, but in large 
quantity they manifest a paralyzing action, and this is especially true of 
potash, which is much more powerful than any of the alkalies. If the 
ordinary saline solution is made with river-water, when passed through 
the heart, the ventricular contractions are much prolonged ; but, if a 
minute quantity of potash is added, the heart-beats assume the normal 
character. This result is probably due to the lime present in the 
river- water, for when a trace of a lime-salt is added to distilled water 
the same lengthening of the ventricular contraction takes place. 

The elimination of the potash salts takes place by various channels, 
chiefly by the kidneys, but they also appear in the saliva, sweat, milk, 
and other secretions. The effect of these salts on the reaction of the 
urine and the differences in result due to the period of administration 
have been pointed out. The state of acidity of the stomach greatly 
affects the reactions of the urine produced by the carbonates of po- 
tassa (Ralfe). The salts of vegetable acids undergo decomposition in 
their passage through the system ; they render the urine alkaline, and 
greatly increase the excretion of free carbonic acid (Parkes). The 
after-condition of the urine is that of increased acidity (Ralfe). The 
nitrate and chlorate of potassa are eliminated unchanged, and do not 
affect the reaction of the urine (Laborde). The notion entertained in 
some quarters that chlorate of potassa parts with its oxygen, is en- 
tirely erroneous. These salts increase the amount of urinary water, 
and, in common with the other members of the family, promote oxi- 
dation and the excretion of urea. While the acetate increases the 
discharge of urinary water, it actually lessens the quantity of solids 
excreted (Parkes). The production of saliva is much increased by the 
chlorate, which is freely eliminated by the salivary glands (Laborde). 
It is a very important fact, which we owe to Dr. Jacobi, of New York, 
that chlorate of potassa irritates the kidneys, and if continued a suffi- 
cient time sets up a chronic nephritis. Others have made similar ob- 
servations, so that the popular use of this supposed harmless agent 
should be discouraged by the medical profession. 

Therapy or the Potash Salts. — Chlorate of potash is in almost 
universal use as a remedy for catarrhal inflammation of the mouth 
and fauces, for acute tonsillitis, aphthous ulcerations of the mouth. 



206 AGENTS INCREASING WASTE. 

stomatitis materna, or nursing sore mouth, and mercurial stomatitis. 
As above stated, the domestic use of this remedy for sore mouth and 
sore throat has become an evil which should be discouraged. For or- 
dinary purposes this remedy should not be employed. The utility of 
the chlorate is, however, so decided in the case of stomatitis materna, 
that all other considerations are merely secondary. In this malady 
large doses (fifteen grains to 3 j three or four times a day) are neces- 
sary, and a less amount will fail to effect a cure. In mercurial stoma- 
titis, ulcerative tonsillitis, diphtheritic angina, etc., the following for- 
mula may be applied locally : r> Potassii chlorat., 3 j ; acid, carbolic, 
3 ss ; glycerini, § j ; aquae, § iij. M. Sig. : Lotion. 

The potash salts are used with great advantage in many stomach- 
disorders. It is an undoubted chemical fact that an excess of acid is 
relieved by an alkali, but the result is not permanent, and the cause of 
the acidity is not removed. Small doses of an alkali, given with a 
bitter before meals, promote the flow of gastric juice, and are a ser- 
viceable combination in atonic dyspepsia, ty Inf. calumbse, f iv ; 
liq. potassae, 3 ss. M. Sig. : A dessert to a tablespoonf ul three times 
a day before meals. Administered after meals, the alkalies will relieve 
the acidity due to an excessive production of acid, or to the acid fer- 
mentation of the starch, sugar, and fat, in the food. An acid given 
before meals is the proper remedy for the excessive formation of the 
acid of the gastric juice. Alkalies render an important service in case 
of indigestion of fats. Not only do they prevent the formation of 
butyric acid, but they assist in the process of emulsionizing the fats 
and help their absorption. In diseases of the liver, and when from 
any cause the flow of bile into the intestine is prevented, alkalies assist 
in the digestion and absorption of fats. The indigestion of obese sub- 
jects, and of the gouty and rheumatic, is usually cured or alleviated 
by alkalies. The lithia salts are generally to be preferred in gouty 
and rheumatic subjects ; but, generally speaking, the bicarbonate of 
potassium is the most useful of the alkali remedies in the above-men- 
tioned maladies. 

The salts of the alkalies, especially the citrates, tartrates, and car- 
bonates of potassium, are useful in inflammatory diseases to lessen heat, 
and to promote excretion of the products of inflammation. When 
oxidation is deficient, as represented in an excess of uric acid in the 
urine, a coated tongue, hebetude of mind — the so-called " bilious state " 
— relief is afforded by the use of the alkalies and their laxative salts. 
The alkaline treatment of acute rheumatism is based on these prin- 
ciples. Although this plan of treatment may not be adapted to all 
cases, there can be no doubt of its utility in respect to a considerable 
proportion. It must be borne in mind, as Dr. Fuller, the most influ- 
ential advocate of the method, informs us, that the alkaline treatment 
consists in a plan, made up in part of the use of bicarbonate of potas- 



ALKALIES. 207 

sium, and in part of certain adjuvants, notably quinine. The main 
point in the treatment consists in the administration of remedies to 
induce an alkalinization of the system as quickly as possible, for when 
this is accomplished further joint and heart complications are not like- 
ly to occur. Fuller gives not less than an ounce and a half of bicarbon- 
ate of potassium, largely diluted with water, in the first twenty-four 
hours of the treatment. Sometimes this salt is given in effervescence 
with lemon-juice — in the proportion of two drachms to an ounce of 
lemon-juice — every three or four hours, or with citric-acid solution. If 
the bowels are torpid, one or more compound cathartic pills are pre- 
scribed in addition. As soon as the urine ceases to exhibit an acid 
reaction — usually at the expiration of twenty-four hours — the quantity 
of potassic carbonate is reduced one half. If the urine continues alka- 
line at the expiration of another period of twenty-four hours, the alkali 
is further reduced one half, and, on the fourth day, the same conditions 
continuing, the treatment ceases to be exclusively alkaline. Then the 
alkali is reduced to the amount necessary merely to keep the urine 
neutral — about a half -drachm of the bicarbonate three times a day, 
and quinine is given. In Dr. Fuller's words, three grains of quinine, dis- 
solved in lemon-juice, is given three times a day in effervescence with 
half a drachm of bicarbonate of potash. In ninety-four cases of acute 
rheumatism thus treated, the average duration, from the beginning of 
treatment, was eleven days. This method is adapted to the treat- 
ment of the plethoric, obese, and muscular subjects, and in the experi- 
ence of the author is not well suited to the pale, delicate, and anaemic 
rheumatic. 

In irritation of the urinary organs due to an excess of acid, the 
combinations of potash with the vegetable acids possess a high degree 
of utility. The liquor potassae is much prescribed under these circum- 
stances, but, as it is very irritating to the stomach, the salts are prefer- 
able, and they are equally effective. The liquor potassii citratis is an 
excellent form for this purpose. There is no doubt that the long-con- 
tinued use of alkalies (citrate, acetate, and carbonate of potassa) will 
effect the solution of renal calculi, which are usually composed of uric 
acid. As the urate of soda is often the nucleus of these formations, the 
soda alkalies should not be used. Small doses taken daily for length- 
ened periods are necessary. Such alkaline waters as the Yichy may 
be used if more agreeable to the patient, but the best results are ob- 
tained by the administration of the citrates and tartrates in a large 
quantity of distilled water. When the urine is acid in any of the forms 
of cystic irritation — from stone, cystitis, stricture, enlarged prostate, 
etc. — great relief is experienced from the use of alkalies, notably the 
liquor potassae, the citrates, acetates, and carbonates of potassium. 
When the urine is alkaline in reaction, no benefit can be derived from 
the use of these remedies. 



208 AGENTS INCREASING WASTE. 

The bitartrate and the acetate of potassium are very certain diu- 
retics, especially the first named. They are most effective when given 
largely diluted with water. A pleasant form in which to administer 
cream of tartar is the familiar " cream-of -tartar lemonade," made as 
follows : A sufficient quantity of the remedy is dissolved in hot water ; 
when cold the clear solution is poured off ; some lemons are cut up and 
put in it, and it is sweetened to the taste. This solution may be drunk 
ad libitum. Considerable stomach and intestinal distress often follows 
the free use of dilute solutions of these potash salts, in consequence of 
the abundant production of carbonic-acid gas. The potash salts are 
indicated as diuretics in desquamative nephritis, and in general dropsy 
from valvidar disease of the heart. By determining a free urinary 
discharge in the one case, they assist in washing out the obstructing 
epithelium in the tubules ; in the other, they relieve the tension of the 
venous system. Yery little is accomplished by the use of alkaline 
diuretics in dropsical accumulations in the various cavities. 

Sodium. — Soda. — Soda ; Natrium, Ger. ; soitde, Fr. Occurs in ir- 
regular flat masses. Is soluble in water and in alcohol. 

Liquor Sodce. — Solution of soda. A colorless liquid, having an ex- 
tremely acrid taste, and a strong alkaline reaction. Dose, t\[ ij — v\ x. 

Sodii Acetas. — Acetate of sodium. In white or colorless crystals, 
which effloresce in dry air, and are wholly soluble in water. Dose, 
grs. v— 3 j. 

Sodii Bicarbonas. — Bicarbonate of sodium. A white, opaque pow- 
der, wholly soluble in water (1 in 12). Dose, grs. v — 3 j. 

Sodii Boras. — Borate of sodium. Borax. In colorless crystals, 
which slightly effloresce in dry air, and are wholly soluble in water. 
Dose, grs. ij— 3j. 

Sodii Carbonas Exsiccatus. — Dried carbonate of sodium. A white, 
hygroscopic powder, having the same properties as the carbonate. 
Dose, grs. ij — grs. x. 

Sodii Carbonas. — Carbonate of sodium. " Large, monoclinic crys- 
tals, rapidly efflorescing in dry air and falling into a white powder ; 
alkaline taste and reaction." Soluble in 1*6 water at 60° Fahr., and 
nearly twice as soluble in hot water. Dose, grs. v — 3j. 

Sodii JVitras. — Nitrate of sodium. Colorless, transparent, rhombo- 
hedral crystals, slightly deliquescent in damp air, having a cooling, 
slightly bitter taste, and a neutral reaction. Soluble in 1*3 water at 
60° Fahr., and in 0'6 boiling water. Dose, 3 j — 1 j. 

Sodii Sutyhas. — Sulphate of sodium. Glauber's salts. Dose, § ss 

Pidveres Effervescentes. — Effervescing powders. Each powder con- 
tains thirty grains of bicarbonate of sodium in one paper, and twenty- 
five grains of tartaric acid in the other paper. (Not oflicial.) 



ALKALIES. 209 

Pulvis Hffervescens Compositus. — Compound effervescing powder. 
Seidlitz powder. Each powder contains forty grains of bicarbonate 
of sodium and one hundred and twenty grains of tartrate of potassium 
and sodium (Rochelle salt) in one paper, and thirty-five grains of tar- 
taric acid in the other paper. 

Antagonists, Incompatible s, and Synergists, are the same as 
those given under potassium. 

Physiological Actions of the Salts of Sodium. — In respect 
to the merely alkaline properties, there is a close correspondence be- 
tween potassium and sodium, but as regards other properties there is 
a wide divergence. The salts of soda are alkaline, and hence neutral- 
ize the acid of the gastric juice. They are readily diffusible. Like 
the potash salts, they increase the alkalinity of the blood, and under 
suitable conditions determine a change in the urine from acid to alka- 
line. The same results follow the administration during or between 
the intervals of digestion, as in the case of the potash salts. The alka- 
linity of the urine induced by soda salts ceases on the day following 
their administration, and the acidity is then increased. Soda has but 
little toxic action besides the local caustic effects. Caustic soda, like 
caustic potash, dissolves albumen, forms soaps with fats, and destroys 
the tissues widely and deeply. It is, however, less active than caustic 
potash. The composition of the blood does not appear to be altered 
by the salts of soda in any reasonable quantity. Laborde, in some 
comparative experiments between chlorate of potassa and chlorate of 
soda, finds that the latter, in treble the quantity of the former, has but 
a transient effect, depressing the temperature half a degree, and caus- 
ing a slight salivation, but producing none of the paralytic symptoms 
which follow the administration of the potash salts. Guttmann had 
previously demonstrated the same facts, and Schonlein, in some stud- 
ies with the carbonate, finds that even in large doses in frogs it rarely 
arrests the heart's movements, only slowing and lengthening the con- 
tractions. Chloride of sodium has, unquestionably, an important office 
in the economy. It forms the principal part of the soluble constitu- 
ents of the ash of all animal substances. Albumen owes its solubil- 
ity in part to the chloride of sodium ; it dissolves pure casein, and 
impedes the coagulation of the fibrin of the blood. In one thousand 
parts of blood there are about four parts of this salt. It is very abun- 
dant in various normal secretions and pathological products. The 
gastric juice is very rich in chloride of sodium, and it probably is the 
source of the hydrochloric acid of the stomach (Lehmann). In the 
course of an inflammation, notably of pneumonia, the chloride of so- 
dium of the system accumulates in the inflamed area, and disappears 
from the urine. Its return to the urine is in the nature of a critical 
phenomenon, and marks the subsidence of the inflammation. The im- 
portance of this salt in the animal economy is doubtless the cause of 
15 



210 AGENTS INCREASING WASTE. 

the universal taste ; all in excess of the needs of the body is excreted, 
chiefly by the kidneys, and with such facility that no accumulation 
takes place. While a necessary amount is of high importance and 
excess is readily disposed of, it is probable that long and habitual in- 
dulgence in a considerable excess increases waste and lowers the vital 
forces. 

Therapy of Sodium Salts. — One of the important salts of soda — 
the phosphate — has been considered under the head of phosphates. 
The soda salts are to be preferred in the alkaline treatment of stomach- 
diseases, but the potash salts when it is desired to promote oxidation 
in the system, or to alkalinize the urine. The urate of soda is insol- 
uble. In case of excess of acid or acid indigestion, the use of soda 
after meals is very effective ; but, while the immediate result is good, 
the after-effect is to increase the production of acid. Those who 
habitually take sodium bicarbonate for acid indigestion suffer severely 
from acidity. Taken before meals, or on an empty stomach, soda 
bicarbonate is useful in atonic dyspepsia, to increase the acid of the 
gastric juice. Acute indigestion, with vomiting, especially if the vom- 
ited matters are very acid, and there is burning at the epigastrium, may 
be quickly relieved by the effervescing powder. The acid diarrhoea 
of children is relieved by the bicarbonate of sodium. This salt may be 
utilized as an emetic in narcotic stupor when other emetics fail to act. 
The author has known this method to succeed in opium narcosis. A 
half to a drachm of bicarbonate in solution in water is swallowed or 
thrown into the stomach by the pump, and this is followed imme- 
diately by a similar quantity of tartaric acid. Brisk effervescence 
ensues, and the contents of the stomach are evacuated. In intussus- 
ception, the same expedient has been practiced with success. The 
solution of bicarbonate of sodium is thrown into the rectum, and is 
followed by the acid. Strong pressure must be made on the anus ; the 
gas forces the bowel back through the ileo-cascal valve and thus re- 
lieves. A stomach or bowel much softened by inflammation, or weak- 
ened by ulceration, is a contraindication of such an expedient. 

In the treatment of the febrile state, and to lessen the acidity of 
the urine, the soda salts have been proposed as substitutes for the pot- 
ash salts. The researches of Laborde, Guttmann, Podcopaew, and 
others, have shown that the former do not have the same powers as 
the latter, and that therefore the substitution can not be made suc- 
cessfully. 

Calcium. — Calx. — Lime ; Kalk, Ger. ; chaux, Fr. 
Calcii Carbonas PrcBcipitatus. — Precipitated carbonate of calcium* 
A fine, white powder, insoluble in water. Dose, grs. v — 3 j. 
Creta Prceparata. — Prepared chalk. Dose, grs. v — 3j. 
Liquor Calcis. — Lime-water. 



ALKALIES. 211 

Liquor Calcis Saccharatus. — Dose, 3 ss — 3 ij (unofficial). 

Testa JPrceparata. — Prepared oyster-shell. Dose, grs. v — 3j (un- 
official). 

Mistura Cretm. — Chalk-mixture. Dose, 3 j — § ss. 

Syrupus Calcis. — Sirup of lime (lime 5 parts to 100 sirup). Dose, 
a teaspoonful or more. 

Calcii Chloridum. — A colorless or whitish salt, sometimes trans- 
lucent, very deliquescent. It is soluble in two parts of water, and 
also in alcohol. Dose, grs. v — 3j, and is preferably administered in 
milk. This should not be confounded zoith chlorinated lime. (Other 
salts of calcium are included under phosphates, hypophosphites, sul- 
phides, and bromides.) 

Antagonists and Incompatibles, and Synergists, the same as 
for potassium. 

Physiological Effects of Calcium Salts. — The important po- 
sition of phosphate of lime in the organism has been already set forth 
under the appropriate head. It is only necessary to state in this con- 
nection that the lime salts are antacid, or alkaline, and as such they 
neutralize the acid of the gastric juice. They act locally as sedatives 
to the mucous membrane. Some of them have a local action merely, 
but the chloride is very diffusible, and the carbonate feebly so. En- 
tering the blood in small quantity, they promote constructive meta- 
morphosis ; but the habitual use of large quantities hastens waste, or 
the retrograde metamorphosis of the tissues. 

Administered in the ordinary way, however, the lime salts furnish 
materials needed by the organism in its growth. The carbonate of 
lime is taken up in limited quantity by the stomach-juices and re-en- 
forces the same constituent in the blood. The chloride of calcium has 
a different office in the economy. It acts in a similar manner to the 
other chlorides, and has close relationship to the iodides. Clinical 
experience has shown that it possesses the ill-defined property known 
as alterative, removes certain toxic or morbific materials, and secures 
their excretion by the organs of elimination. The recent studies of 
the therapeutical actions of chloride of calcium have shown it to pos- 
sess the remarkable property of an antagonist or antidote to the stru- 
mous constitution. No mere physiological investigation could have 
demonstrated this power ; it is an empirical fact which we can not 
explain as yet by physiological methods. It has been shown, how- 
ever, that under its use enlarged and cheesy lymphatics gradually 
resume their normal condition, tubercular deposits undergo a process 
of calcification, and ulcerating cavities discharge their contents and 
cicatrize. It can not, of course, be asserted that such surprising 
changes frequently occur, but, that they do sometimes take place, 
clinical experience has proved. From this point of view, then, chlo- 
ride of calcium assumes a high degree of importance. 



212 AGEXTS INCREASING WASTE. 

Therapy of the Calcium Salts. — No remedy is more frequently 
prescribed for vomiting than lime-water. It is given very often with 
milk, one half, one fourth, as may be, and the combination is effective 
in arresting vomiting due to acute troubles of the abdominal organs, 
and also useful in vomiting of cerebral and reflex origin. When the 
milk-cure is prescribed, lime-water is frequently added to enhance the 
digestibility of the milk. Carbonate of lime is a useful restorative 
and antacid in the acid indigestion, and in the diarrhoea of strumous 
children. By Dr. Warburton Begbie and by Dr. Coghill the chloride 
of calcium is strongly urged, as the most efficient remedy in the feeble 
digestion and disordered secretions of strumous children. The latter 
especially commends the use of the chloride in " children when the 
sleep becomes restless and troubled, the breath fetid, the tongue foul 
and coated, the tonsils enlarged, the evacuations irregular and offen- 
sive, with deficient secretion of bile." In the colliquative diarrhoea 
of the strumous, it is said to be curative, even when accompanied by 
enlargement of the mesenteric glands. According to the published 
observations of Begbie, Coghill, and Bell, we possess no agent so val- 
uable in the wasting diseases of children of strumous origin, in glan- 
dular enlargements^ etc. The testimony which has been lately pub- 
lished in respect to the curative power of chloride of calcium in 
consumption is certainly very striking, and especially in those cases 
succeeding to glandular enlargements heretofore so little amenable 
to treatment. Carbonate of lime in five-grain doses ter die is said to 
arrest the sweating of phthisis. According to Rodolfe, chloride of 
calcium cures chorea speedily. 

Lithium. — Lithium. 

Lithii Garbonas. — Carbonate of lithium. A white powder, spar- 
ingly soluble in water (1 in 100), and having a feeble alkaline reaction. 
Dose, grs. ij — grs. x. 

Lithii Citras. — Citrate of lithium. A white powder, deliquescent 
and soluble in twenty-five parts of water. 

Lithii Salicylas. — Salicylate of lithium. A white powder, deli- 
quescent on exposure to air, having a sweetish taste and a faintly acid 
reaction. It is freely soluble in water and in alcohol. Dose, gr. v — 3 j. 

Lithii Benzoas. — Benzoate of lithium. A white powder, or small 
shining scales, permanent in the air, having a cooling, sweetish taste 
and a faintly acid reaction. Soluble in four parts of water and twelve 
parts of alcohol at 60° Fahr. Dose, gr. ij — gr. xv. 

Antagonists and Incompatibles, and Syneegists, are the same 
as for the other alkalies. 

Physiological Actions of the Lithium Salts. — These remedies 
have strong alkaline and basic properties, and act on the organism of 
man in the same manner as the other members of the group. The 
compound of uric acid and lithium is readily soluble, differing in this 



ALKALIES. 213 

respect from the urate of soda. It is said that the lithium salts alka- 
linize the urine more decidedly than even the potash salts. 

Therapy of the Lithium Salts. — Garrod first introduced these 
remedies into medical practice for the treatment of rheumatism, and in 
his recent Lumleian lectures has demonstrated anew their exceptional 
value. Recently the compound of lithium and salicylic acid has been 
brought forward as a more effective remedy in the rheumatic diseases. 
The subacute and chronic cases, and the so-called rheumatic gout, are 
the forms of the disease in which the lithium salts are most serviceable. 
In the so-called uric-acid diathesis, in renal calculi composed of uric 
acid, and in irritable bladder from an excess of acid in the urine, the 
salts of lithium are useful. In the case of a renal calculus a very pro- 
tracted use of a well-diluted solution is necessary. The carbonate of 
lithium, in carbonic-acid water and arseniate of soda dissolved in the 
same solution, has been highly extolled of late as a cure for diabetes. 
Dr. Martineau, the author of the plan, directs three grains of the lithium 
salt and -^ grain of arseniate of soda to be dissolved by pressure in 
two pints of carbonic-acid water — quantity sufficient for three doses. 

External Applications of the Alkalies. — A solution of com- 
mon soda (impure bicarbonate) freely applied will often remove the 
fetid sweat of the feet, and the odorous emanations which in some 
subjects escape from the axillary glands. Acne occurring in persons 
with a greasy skin, and prominent and black sebaceous follicles, may 
sometimes be cured by alkaline lotions. 3 I^iq. potassse, 3 j ; aquae 
rosae, | iv. M. Sig. : Apply with a soft sponge twice a day. For 
acute eczema where there is much serous discharge, no applications are 
more efficient than solutions of the alkalies. $ Sodii carbonat., 3 ss ; 
aquae, Oj. M. Sig. : The eruption to be covered with lint soaked in 
this solution. Stronger solutions can be used in old cases where the 
skin is much thickened. As alkalies, by absorbing the moisture and 
combining with the fat of the sebaceous matter, make the skin dry 
and harsh, it is useful to apply some form of oil after these alkaline 
applications, certainly after the stronger solutions. Mutton-suet is one 
of the best fats for this purpose. 

In prurigo great relief is often obtained by an alkaline warm bath 
at bedtime. A solution of carbonate of potassium ( 3 iij — 5 iv) is 
recommended by Trousseau as a remedy for that obstinate affection — 
pruritus vulvce. In freckles, sunburn, and tan, the following lotion is 
useful : IJ Potassii carbonat., 3 iij ; sodii chloridi, 3 ij ; aquae rosae, 
| viij ; aquae aurantii flor., f ij. M. Sig. : Lotion. 

To cleanse the scalp from dandruff (pityriasis), there is no more 
suitable application than a saturated solution of borate of soda. Pow- 
dered borax, mixed with sugar, is a domestic remedy for aphthm of 
children ; it is simply placed on the tongue. A saturated solution of 



214 AGENTS INCREASING WASTE. 

borax in rose-water is a useful application to remove freckles, and to 
allay pruritus vagince. 

For the cure of corns no application is so certain, prompt, and ef- 
fective as liquor potassse. It should be applied by means of a glass 
rod or pine-wood splinter to the summit of the corn, and the tissue 
softened by it scraped off. By successive applications the callosity is 
removed without pain or discomfort. 

The so-called ingrowing toe-nail may be cured by the application 
to the irritable granulation, at the margin of the nail, of a solution of 
liquor potassse ( 3 ij — f j). This solution is to be applied on cotton- 
wool, to the margin of the nail and to the ulcerated surface of the toe, 
until the nail is so far softened that it can be cut away without pain. 

Unhealthy and sloughing ulcers may be destroyed by potassa fusa, 
and a healthy granulating surface be left. No more efficient escharotic 
can be used in hospital gangrene. As it penetrates deeply and widely, 
great care must be used to limit its application to the affected parts, 
and, as soon as the destruction is sufficient, to check the further exten- 
sion of the caustic by washing with a dilute acid. Vienna paste — which 
is a mixture of equal parts of potassa and lime made into a paste with 
alcohol — is milder in operation, and therefore usually preferred. Caus- 
tic potash was formerly much employed to make issues, to open ab- 
scesses and carbuncles, but these applications are now quite obsolete. 
Induration of the cervix uteri and chronic metritis (hyperplasia of the 
connective tissue) are, it is said (Dr. Bennet), very effectively treated 
by application of caustic potassa and potassa cumcalce; but such pow- 
erful means must be used with great caution, if at all. In carcinoma, 
when the disease is limited to the neck of the uterus and not too far 
advanced, caustic potassa may be used with advantage to destroy the 
diseased surface. This caustic is quite as efficient as any, probably, 
for the escharotic treatment of cancer when this method of treatment 
is employed. 

A solution of the bichromate of potassium (gr. j — grs. x — 3 iv) is 
an excellent local application in the treatment of the catarrhal state of 
the nasal, buccal, or vaginal mucous membrane. A saturated solution 
of this salt may be used as a caustic in place of chromic acid. 

Carbonate of soda in saturated solution has been used lately with 
signal success in the treatment of burns: it allays the pain, checks 
suppuration, and favors healing (McClellan, Pring, etc.). Cloths 
dipped in a saturated solution, and covered with oiled silk, are kept 
on the part, the solution being renewed as rapidly as may be neces- 
sary. Dr. Duckworth reports that toothache may be quickly allayed 
by holding a solution of carbonate of soda in the mouth. Recently 
chlorate of potash has been used with success in the treatment of epi- 
thelioma. This practice was first suggested by Yidal in the treatment 
of chancroid, and has since been successfully employed in the treat- 



ALKALIES. 215 

ment of obstinate ulcers, epithelioma and cancer (Fereol, Leveque). In 
the simpler cases a saturated solution may be kept on, but in epithe- 
lioma and cancer the powdered chlorate is thickly applied over the sore. 
It is said to allay pain, remove fetor, and promote cicatrization when 
so applied. The internal use of the salt is recommended in conjunc- 
tion with the topical application in cancer, epithelioma, and lupus. 

Authorities referred to : 

Basham, Dr. W. R. The Practitioner, vol. v, p. 257. 

Begbie, Dr. J. Warburton. The Edinburgh Medical Journal, July, 1870, p. 46. 

Bell, Dr. Robert. The Lancet, August, 1877, p. 275. 

Binz, Dr. C. Archiv fur experiment. Pathologie und Pharmacologie, vol. x, p. 153. 
Ueber Reduction des chlorsauren Kalis. 

Buchheim, Prop. Dr. R. Archiv fur experiment. Pathol, und Pharmacol., Band iii, p. 
252. Ueber die Wirkung der Kaliumsalze. 

Coghill, Dr. J. G. Sinclair. The Practitioner, vol. xix, p. 247. Therapeutic Notes 
on the Chloride of Calcium. 

Duckworth, Dr. Dyce. The Practitioner, April, 1875, p. 250. 

Fuller, Dr. H. W. The Practitioner, vol. ii, p. 129. The Alkaline Method in the 
Treatment of Rheumatism. 

Guttmann, Dr. P. Virchovfs Archiv, Band xxxv, p. 450. Wirkung der Kali und 
Natronsalze. 

Hummel, Meinrad. Allg. Wiener med. Zeit., 23-26, 1878. Ueber das Kalium Ohio- 
ricum. 

Isambert, Dr. Gaz. Med. de Paris, 1874, Nos. 17, 35, 41, and 43. Nouvelles expe- 
riences sur V action physiologique, toxique et therapeutique du chlorate depotasse. 

Kohler, Prof. Dr. H. Centralblatt f. d. med. Wiss., 1877, No. 38, p. 673. Zur 
Wirkung der Kaliumsalze auf Warmbluter. 

Laborde, Dr. J. V. Bull. Gen. de Therap., 1874, pp. 247, 319, and 354. Etude com- 
parative de V action physiologique des chlorates de potasse et de soda, etc. 

Marchand, Dr. F. Virchoiifs Archiv, Band lxxvii, p. 455. Ueber die Intoxication 
durch Chlorsaure Baize. 

McClellan, Dr. Ely. Louisville Medical News, 1878. On Relief of Burns by a Satu- 
rated Solution of the Carbonate of Soda. 

Parkes. On the Urine, p. 158. 

Perl, Dr. Leopold. Virchow's Archiv, vol. lxxiv, p. 54. Ueber die Resorption der 
Kalksalze. 

Podcopaew, Dr. Virchovfs Archiv, Band xxxiii, p. 505. Vergleichende Untersuchungen 
uber die Wirkung des Chlorkalium und Chlornatrinm auf den thierchen Organismus. 

Pring, Dr. E. J. Philadelphia Medical Times, March 16, 1878, p. 273. Note on the 
Use of Bicarbonate of Soda in Burns. 

Rabuteau, Dr. Gazette Hebdom., xliii, 1868, p. 617. Recherches sur V elimination et 
sur proprieles osmotiques du sulfate de sodium. 

Ralpe, Dr. C. Lancet, November, 1878, p. 651. Observations in Urinary Pathology 
and Therapeutics. 

Ringer and Murrell. Journal of Physiology, vol. xii, p. 5. Influence of the Chloride 
of Potassium on the Nervous System of Frogs. 

Schonlein, K. Arch. f. d. ges. Physiol., vol. xviii, p. 26. Versuche uber einige physi- 
ologische Wirkung en des Natriumcarbonats. 

Valentin, Dr. Zeit. fur Biol, vol. xiv, p. 320. Die Giftwirkungen welche Salzba'der 
auf Frosche ausuben. Virchow u. HirscNs Jahresbericht. 



216 AGENTS INCREASING WASTE. 

ALKALINE MINERAL SPRINGS. 
1. North America. 

Bladon Springs, Choctaw County, Alabama. A rolling, pine-woods 
region. 

They contain carbonate of soda, carbonate of magnesia, carbonate 
of iron, carbonate of lime, sulphate of lime, carbonic-acid gas, sul- 
phureted hydrogen (traces), and chlorine. 

Congress Springs, Santa Clara County, California. In the Coast 
Range of mountains. 

They contain carbonate of soda (15*418 grains to the pint?), car- 
bonate of iron, carbonate of lime, chloride of sodium (14*894 grains to 
the pint), sulphate of soda, etc. They are highly charged with car- 
bonic-acid gas. 

California Seltzer Springs, Mendocino County, California. 

They contain carbonate of soda, carbonate of magnesia, carbonate 
of lime, carbonate of iron (a trace), and chloride of sodium. They 
are also highly charged with carbonic-acid gas. 

Perry Springs, Pike County, Illinois. 

They contain carbonate of potassa, carbonate of magnesia, carbo- 
nate of iron, carbonate of lime, sulphate of soda, silicates of soda and 
potassa. Temperature of the water is from 48° to 50° Fahr. 

St. Lonis Spring, Gratiot County, Michigan. 

This water contains carbonate of soda (7*684 grains to the pint), 
carbonate of magnesia, carbonate of iron, carbonate of lime (5*019 
grains to a pint), sulphate of lime (6*925 grains to a pint), silicate of 
lime, and silica. This is one of the so-called " magnetic springs " — 
the magnetic property being due not to the water, but produced by 
the magnetization with terrestrial currents of the vertical iron tube 
through which the water flows. It is unfortunate that this part of 
the peninsula of Michigan, in which the numerous alkaline and saline 
springs abound, is very decidedly malarious. 

Buffalo Lithia Spring, of Virginia. Contains well-defined traces of 
lithia, and is alkaline. This has been used with great advantage in 
gouty, rheumatic, and r^nal affections. 

The Hot Springs, Bath County, Virginia, contain carbonates of lime 
and magnesia, sulphates of lime, magnesia, and soda, and chlorides of 
sodium, calcium, and magnesium. The temperature of the water 
ranges from 100° to 106° Fahr. 

The Warm Springs, Bath County, Virginia, have a composition 
similar to the hot springs, but the temperature of the water is some- 
what less. At these springs, extensive bathing-pools have been con- 
structed. The best results have been obtained from the bathing, con- 
joined with the internal use of the water. 

Berkeley Springs are also situated in Bath County. The waters 



ALKALINE SPRINGS. 217 

are alkaline, of a constant temperature of 72° to 74° Fahr., and are 
employed by bath and internally. 

Rockbridge Baths, Rockbridge County, Virginia. A mountainous 
region. 

They contain magnesia and iron, with a small quantity of iodine. 
Temperature, 74° Fahr. Used chiefly in the form of baths. 

Capon Springs, Hampshire County, West Virginia. 

This water contains carbonate of soda, carbonate of magnesia, and 
traces of iodine and bromine. The temperature of the water is 66° 
Fahr. These springs are situated in a romantic mountain-region. 

Besides the above, there are numerous weakly-alkaline waters, such 
as Bethesda and others of the Waukesha region of Wisconsin, in South- 
ern Michigan, and in many parts of the United States. It is impos- 
sible to mention all of them, and especially to set forth the rather pre- 
tentious claims, or recognize the apocryphal cures, so persistently and 
profusely published by their owners. Unquestionably good results 
have been wrought by these waters. Besides the positive there" are 
negative virtues in these numerous mineral springs : they take the 
place of the indiscriminate drug administration which is one of the 
evils of the time. 

2. European. 

Vichy, Central France. 

There are several springs — Grande Grille, Puits Carre, Hbpital, 
Celestins, De Mesdames, and others. The waters contain carbonates 
of soda, of potassa, magnesia, and lime, sulphate of soda and chloride 
of sodium, phosphate of soda, arseniate of soda (a trace), carbon- 
ates of strontia and iron. The gas, which is abundant, is carbonic 
acid. 

In the Vichy region there are numerous alkaline springs having 
similar properties. The temperature of the waters varies from 58° 
Fahr. ( Celestins) to 178° Fahr. ( Chaudes Aigues). 

Mont Dore*, valley of the Dordogne, France. 

The waters are weak alkaline, and have a temperature from 90° to 
104° Fahr. Their principal constituent is carbonate of soda* These 
springs lie among the volcanic mountains of Auvergne, at an eleva- 
tion of 3,300 feet. 

Vals, Ardeche, France. 

The waters of these cold springs are remarkable for the quantity of 
carbonate of soda which they contain. They are abundantly charged 
with carbonic-acid gas. 

Ems, on the Lahn, Germany. 

These waters contain, according to the analysis of Fresenius, 14 to 
15 parts of bicarbonate of soda, 7 parts of chloride of sodium, and 1*7 
part each of bicarbonate of lime and bicarbonate of magnesia, with 
sulphates of soda and potash, and bicarbonates of iron, manganese, 



2 IS AGENTS INCREASING WASTE. 

baryta, strontia, and alumina in small quantity, to the pint. The gas 
is carbonic acid, from 6 to 8 cubic inches to the pint. 

Neuenahr, valley of the Ahr, between Bonn and Coblentz, Ger- 
many. 

The waters of these springs have a composition similar to those of 
Ems, but have about half as much soda and very little salt. 

Salzbrunn, upper Silesia, near Freiburg, Germany. 

These waters are very rich in carbonate of soda. 

Gleicheilberg, near Gratz, Styria, Austria. 

These springs are much more alkaline than Ems. The waters con- 
tain from 20 to 27 parts of carbonate of sodium, 19*5 of chloride of 
sodium, and 7'8 of carbonate of magnesium. The water is highly 
charged with carbonic-acid gas. 

Therapeutical Uses of the Alkaline Mineral Waters.— As we have 
seen that alkalies taken before meals increase the production of acid 
gastric juice, the alkaline mineral waters are serviceable in atonic dys- 
pepsia. They are especially useful in catarrh of the duodenum and 
of the bile-ducts, and in the jaundice dependent on this state of the 
mucous membrane. In incipient cirrhosis, in congestion of the ported 
circulation, and in hemorrhoids due to the hepatic obstruction, they 
render important service. Obesity, which is frequently diminished by 
a course of alkalies, is better treated by alkaline waters, for at the 
springs these patients can be induced, more easily, to conform to the 
plan of exercise and diet necessary in these cases. 

The alkaline springs have long had a deserved reputation for 
the cure of gout and rheumatism. With the internal use of the 
waters should be conjoined baths, douches, etc. Gout and rheu- 
matic affections of internal organs are equally amenable to the same 
treatment. 

These alkaline waters, long used, are especially serviceable in the 
so-called lithic-acid diathesis. There is little doubt that the continuous 
use of alkaline waters for a long period will cause the solution of uric- 
acid renal calculi. For this purpose those alkaline waters rich in 
potassa are preferable. 

When diabetes is hepatic in origin, and occurring in obese subjects, 
the alkaline mineral waters are extremely useful. A suitable diet 
should be enjoined. 

The following domestic mineral waters maybe advised in the above 
states : Bladon Springs ; the California Seltzer ; Perry Springs ; St. 
Louis springs ; but especially Capon, Saratoga, Buffalo-Lithia, Bethes- 
da, and other alkaline springs of Wisconsin. 

Of the foreign, the most important are Vichy, which is import- 
ed at a moderate price, Mount Dore, Vals, Ems, Salzbrunn, and 
Gleichenberg. 

The psychical influences of change of scene, associations, and cli- 



SALINE SPRINGS. 



219 



mate, are largely concerned in the results of treatment with the 
waters of mineral springs. 



SALINE MINERAL WATERS. 

1. KOETH AMEEIOAN. 

St. Catharine's Wells, St. Catharine's, Ontario, Canada. 

These contain chloride of sodium (217 to 375 grains to the pint), 
chlorides of potassium, magnesium, calcium (108 to 127 grains to the 
pint), sulphate of lime, and iodide and bromide of magnesium. A 
concentrated water prepared by evaporation is used, properly diluted 
by patients at a distance for internal diseases, and at the wells, ex- 
ternally. 

These waters are diluted with ordinary water to three fourths 
or seven eighths, before they are drunk. They are chiefly used as 
warm baths. The diseases in which they have been found most 
beneficial are chronic gout, rheumatic gout, chronic rheumatism, 
and gouty and rheumatic diseases, strumous diseases, engorgement 
of the pelvic viscera, chronic metritis, uterine fibroids, hcemor- 
rhoids, etc. 

Spring Lake Well, Ottawa County, Michigan. 

The water of this spring contains chloride of sodium (50*691 grains 
to the pint), chloride of calcium (14*177 grains to the pint), chloride 
of magnesium, carbonates of soda, manganese, and iron, in small quan, 
tity, sulphate of soda (5*837 grains to the pint), bromide of magnesium - 
and a trace of lithia. 

These waters are applicable to the treatment of gout, rheumatism, 
strumous diseases, etc. The waters are drunk and used as warm 
baths. 

Saratoga Springs, Saratoga, New York. 

In general terms, these waters contain chloride of sodium, the alka- 
line carbonates, and are highly charged with carbonic-acid gas. The 
springs are numerous, and differ somewhat in composition. I subjoin 
a tabular statement (see page 207) of the analyses of the different 
waters, from the excellent work of Dr. Walton. 

These waters are useful in plethora of the abdominal viscera, in 
obesity, in habitual constipation due to deficient secretion, in plethora 
of the pelvic viscera, hemorrhoids, etc. The waters of the Pavilion 
and Geyser Springs, owing to the quantity of lithia which they contain, 
are especially serviceable in chronic gout, chronic rheumatism, rheu- 
matic gout, and affections dependent on these diatheses. The Colum- 
bian, Pavilion, Eureka, and Excelsior, containing a considerable pro- 
portion of iron, are more especially adapted to cases of the above- 
mentioned disorders, in which anaemia exists, but they must be drunk 
with caution by the plethoric. 



220 



AGENTS INCREASING WASTE. 



ONE PINT CONTAINS- 



SOLIDS. 

Carbonate of soda 

Carbonate of magnesia. 

Carbonate of iron 

Carbonate of lime 

Carbonate of lithia 

Carbonate of strontia. . 
Carbonate of baryta . . . 
Chloride of potassium . 
Chloride of sodium. ... 

Sulphate of potassa 

Sulphate of soda 

Sulphate of magnesia. . . 

Phosphate of soda 

Phosphate of lime 

Iodide of sodium 

Bromide of sodium . . . 
Fluoride of calcium. — 

Biborate of soda 

Alumina 

Silicate of potassa 

Silicate of soda 

Silica 

Organic matter 



Total. 



Gas. 

Carbonic acid. 



S >a Q 



Grains. 

3-024 
4-069 
0-135 

11-443 
154 
trace. 
0-050 
1-122 

4S-766 
0-201 



trace. 



0-011 
091 
trace, 
trace. 
0-153 



0-283 
trace. 



69-502 

Cubic in. 

51 
(1866.) 



§,£ 



Grains. 
0-934 
9-019 
0-031 

12-449 
0-374 
trace. 
0-095 
1-006 

50-055 
0111 



0-002 



0-017 
1-069 
trace, 
trace, 
trace. 



105 
trace. 



75-267 

Cubic in. 

49 
(1871.) 



. 9 

go 



Grains. 

0-372 
13 072 

0-101 
14-815 



trace. 
0-178 
1-199 
63-746 
trace. 



o-ooi 



0-025 
0-192 
trace. 



0-016 



0-157 
trace. 



93-874 



Cubic in. 
47 



Grains. 

0-7S2 
3-182 
0-079 
9-520 
0-163 
trace. 
0-008 
0-536 
63-328 
346 



0-003 



0-001 
0-033 
trace, 
trace. 
0-052 



0-182 
trace. 



Cubic in. 

43 
(1872.) 



Grains. 

1-336 
8-461 
0-698 
8-500 



33-375 



47-946 



Cubic in. 
34 



Grains. 

0-327 
5-650 
233 

10-432 
0-744 
trace. 
0-090 
0-958 

57-4S0 
0-254 



0-001 



0-00J 
0-123 
trace, 
trace. 
0-041 



0-394 
trace. 



Cubic in. 
41 



•SO 



Grains. 
0-405 
5 399 
065 
8-084 
0-380 

o-ooi 

0-094 

1-078 

17-734 



0-002 



006 
0-106 
trace, 
trace. 
0-012 



0-393 
trace. 



33-764 






Grains. 
2-552 
2-988 
0-155 
7-804 
0-071 
trace, 
trace. 
0-167 
16-786 
0-069 



trace. 



0-004 
0-079 
trace, 
trace. 
0-047 



0-320 
trace. 



31-042 



Cubic i 
40 



Alumina and sesquioxide of iron. 



ONE PINT CONTAINS— 


ill 

w ** o 


a 

Ca O 
Sfi r - 

Mo * 


c 

1 

1 


A 

-^ a 
!< 

►4 

PS 


A* 

11 

P5 




& 


Solids. 


Grains. 

6-175 
10-322 
0-0S9 
14-793 
0-549 
0-041 
0-206 
3-079 
70-260 
trace. 


Grains. 

1-097 
4-536 

o-iio 

10-795 
0-124 
trace. 

o-oio 

1-212 

49-795 

0-675 


Grains. 

1-107 
2 618 

"7 : 324" 
0-016 


Grains. 
0-625 
3-667 
0-375 
5-165 


Grains. 
1-S75 
4-042 
0-402 
9-625 


Grains. 

4-281 

4-SS3 

0-578 

12-249 


Grains. 
1-212 




5-568 




0135 




8-S45 




0-339 






















074 




0-686 
8-699 








1040 


Chloride of sodium 


20-852 


46 330 


37-332 


42-058 




269 








0-165 














0-26S 








trace. 


trace. 


trace, 
trace. 






001 














031 
0-276 
trace, 
trace, 
trace. 


0-015 
0-071 
trace, 
trace, 
trace. 


0-583 
0-196 


0-529 


0-449 


0-008 




051 
























10-219 


0-029 


" 6-875 

0-500 




0-038 




















Silica 


0-013 
trace. 


0-160 
trace. 


0-339 


0-067 


2 0-125 


401 


















Total 


105-834 

Cubic in. 
57 

(1870.) 


68-650 

Cubic in. 
50 


21-003 
Cubic in. 


31-827 

Cubic in. 
29 


64-343 

Cubic in. 
31 


59-S97 

Cubic in. 
40 


60-0S9 


Gas. 


Cubic in. 
39 




(1570.) 



8 Silica and alumina. 



SALINE SPRINGS. 221 

Ballston Spa, Ballston, Saratoga County, New York. 

These waters are similar in composition to the waters of the Sara- 
toga Springs, but they are richer in mineral constituents. 

Bedford, Bedford County, Pennsylvania. These waters are pur- 
gative saline in character and composition, somewhat like those of 
Saratoga, but contain more iron. 

There are probably in no part of the world more admirable mineral 
springs than those of Saratoga, and of Bath County, Virginia. Physi- 
cians of this country have not given them the attention they deserve, nor 
have their owners been sufficiently awake to their remarkable utility. 

2. Eueopean - . 

Cheltenham, Gloucestershire, England. 

These spas are saline aperient, iodureted saline, iodureted-magne- 
sian saline, and the waters contain a good deal of carbonic acid. The 
season is from July to October. These waters are chiefly serviceable 
in dyspepsia, hepatic affections, and constipation. Some of the springs 
at Cheltenham contain iron, and the water of these is employed in 
chlorosis and anwmia. 

Leamington, Warwickshire, England. 

These waters contain chlorides of calcium and sodium, and sulphate 
of soda, with carbonic acid. They are much prescribed in dyspepsia, 
acidity, and hepatic troubles, constipation, etc. 

Adelheidsquelle, Heilbrun, Bavaria. Altitude, 2,000'. Tempera- 
ture of spring, 50° Fahr. Season, May to September. 

This valuable water contains chloride of sodium, carbonate of 
sodium, iodide and bromide of sodium, etc. ; carbonic acid, 13-18 
cubic inches. It is highly prized in strumous diseases, rheumatism, 
gout, affections of the skin, and pelvic troubles of females (chronic 
metritis, fibroids, etc.). 

Baden-Baden. Altitude, 616'. Mean annual temperature, 48° Fahr. 
Season, May to October. 

According to Bunsen's analysis, these waters contain chloride of 
sodium, bicarbonate of lime, magnesia, and iron, sulphates of lime and 
potash, arseniate of iron (a trace), chloride of potassium, bromide of 
sodium (traces), etc. ; carbonic-acid gas. The Meurquelle contains 
2*3694 grains of chloride of lithium in 20 ounces. 

Carlsbad, Bohemia. Altitude, 1,200'. Season, June to September. 

These waters contain sulphate of soda, carbonate of soda, chloride 
of sodium, sulphate of potash, carbonate of lime, etc. Marktbrunnen 
contains, besides these ingredients, a small quantity of carbonates of 
lithia, strontia, and manganese, and iodide and bromide of sodium ; 
the gas is carbonic acid. 

The Carlsbad water is highly prized in affections of the liver and 
portal system, uterine diseases, gout, rheumatism, and diabetes. 



222 AGENTS INCREASING WASTE. 

Friedrichshall, Saxe-Meiningen, Germany. Bitter water. 

According to Liebig, this water contains sulphate of soda, 46*51 
grains ; sulphate of magnesia, 39*55 ; chloride of sodium, 61*10; chlo- 
ride of magnesium, 30*25 ; sulphates of potash, 1*52, and of lime, 10*34 
grains. Carbonic-acid gas, 5*32 cubic inches. 

This is aperient, and is used in diseases of the stomach, liver, intes- 
tines, and kidneys. It is imported in quart-bottles, and is much pre- 
scribed as a laxative in habitual constipation, in hepatic troubles, pleth- 
ora of pelvic organs, etc. 

Homburg, Central Germany. Altitude, 600'. Open all the year, 
but the season is from May to September. Temperature, 50° to 53° 
Fahr. 

According to the analysis of Liebig and Hofmann, these waters 
contain chlorides of sodium (79 to 104 grains), potassium, magnesium, 
and calcium, carbonates of lime, magnesia and iron, and sulphates of 
soda and lime. Free carbonic acid, 48 cubic inches. 

In therapeutical action they are laxative, and are prescribed in 
habitual constipation, dyspepsia, abdominal and pelvic plethora, obes- 
ity, hypochondriasis, hysteria, etc. 

Kissingen, Bavaria. Altitude, 800'. Temperature of springs, 50° 
Fahr. The season is from May to September. 

Liebig's analysis has shown that these waters contain chlorides of 
sodium (17*52 to 44*71 grains), potassium, lithium, and magnesium, 
sulphates of lime and magnesia, carbonates of lime and iron, bromide 
and iodide of sodium, etc. They are highly charged with carbonic 
acid. 

Kissingen waters are laxative, and are used in dyspepsia, hepatic 
obstructions, albuminuria, diabetes, etc. 

Kreutznach, Rhenish Prussia. Altitude, 285'. Season is from June 
to September. 

This powerfully alterative water contains chloride of sodium (72 to 
108 grains to the pint), chloride of calcium (13 to 22 grains to the 
pint), chlorides of magnesium, potassium and lithium, carbonate of 
lime and iron, bromide and iodide of magnesium. 

The mother-liquor of Kreutznach contains 2,484 grains of solid 
matter in sixteen ounces. 

These waters are extremely serviceable in constitutional syphilis, 
strumous diseases, affections of the skin, rheumatism, gout, engorge- 
ment of the abdominal and pelvic organs, hepatic diseases, etc. 

Marienbad, Bohemia. Altitude, 1,900'. Season is from May to 
September. 

The principal constituents of this water are sulphate of soda, bi- 
carbonate of soda, chloride of sodium, bicarbonate of lime, bicarbonate 
of magnesia, and salts of lithia, strontia, iron, and manganese, in small 
quantity ; carbonic-acid gas. 



AMMONIUM. 223 

Laxative, and used in hepatic disorders, dyspepsia, habitual con- 
stipation, gravel, gout, etc. 

Reichenhall, Upper Bavaria. Altitude, 1,407'. Mean temperature 
of spring, 56° Fahr. ; of summer, 64° Fahr. ; of autumn, 54° Fahr. 
Season, July and August. 

Used only for baths. Inhalations are practiced here on a large 
scale. " The compressed-air cure " is also a prominent feature of the 
curative methods. /Scrofula, phthisis, and affections of the throat, are 
chiefly treated. 

The waters are rich in chlorides of sodium and magnesia, and sul- 
phates of soda and lime. 

Seidlitz, Bohemia. 

The chief constituents are sulphate of magnesia, sulphate of soda, 
carbonate of lime, sulphate of lime, sulphate of potash, and chloride 
of magnesium. 

Saline purgative. 

Selters, Nassau. 

Kastner's analysis has shown that this water contains bicarbonate 
of soda, chloride of sodium, bicarbonates of lime and magnesia, iron 
and manganese, phosphates of lime, alumina and soda, bromide of 
sodium, etc. Highly charged with carbonic acid. 

Laxative and alterative. 

Authorities referred to : 

Braun, Dr. Julius. Systematisches Lehrbuch der Balneotherapies Berlin, 1873. 

Macpherson, Dr. John. The Baths and Wells of Europe, second edition, London, 
Macmillan & Co., 1813. 

Moorman, Dr. J. J. Mineral Springs of North America, Philadelphia, J. B. Lippin- 
cott & Co., 1873. 

Yalentiner, Dr. Th. Handbuch der allgemeinen und speciellen Balneotherapie, Ber- 
lin, 1873. 

Walton, Dr. George E. Mineral Springs of the United States and Canada. 

AMMONIUM AND ITS PREPARATIONS. 

Peepaeatioxs. — Ammonii Benzoas. Benzoate of ammonium. 
Benzoic acid and ammonia. In minute, white, shining, thin, four-sided, 
laminar crystals; bitter, saline, and somewhat balsamic in taste; soluble 
in water (1 in 5), and in rectified spirit (1 in 12). Dose, gr. v — gr. xv. 

Ammonii Carbonas. — Carbonate of ammonium. In white, trans- 
lucent masses, with a pungent and ammoniacal odor, soluble in water 
(1 in 4). Dose, gr. v — gr. x. 

Ammonii Chloridum. — Purified chloride of ammonium. Sal-am- 
moniac. In a snow-white, crystalline powder, soluble in three parts 
of cold water, and spariugly soluble in alcohol (1 in 55). Dose, gr. 

Trochisci Ammonii Chloridi. — Troches of chloride of ammonium. 



224 AGENTS INCREASING WASTE. 

(Ammonium chloride, sugar, tragacanth, aud sirup of tolu.) Each 
troche contains tyro grains of chloride of ammonium. 

Ammonii Yalerianas. — Valerianate of ammonium. A white salt 
in quadrangular plates, having the odor of valerianic acid, and a sharp, 
sweetish taste, and is very soluble in water and in alcohol. Dose, gr. 
j— gr. v. 

Ammonii Phosphas. — Phosphate of ammonia. In colorless, trans- 
parent prisms, soluble in water (1 in 4), but insoluble in alcohol. Dose, 
gr. v— 3j. 

Aqua Ammonim. — Water, or solution, of ammonia ; contains ten 
per cent by weight of gas. A transparent, colorless liquid, having a 
very pungent odor, and a strongly alkaline reaction. Dose, m, v — 
3 ss, well diluted with water. 

Liquor Ammonii Acetatis. — Solution of acetate of ammonium. 
Spirit of Minderer. Dose, 3 j — 1 j. 

Spiritus Ammonice. — Spirit of ammonia. A solution of ammonia- 
cal gas in alcohol. Dose, th, x — 3 j. 

Spiritus Ammonim Aromaticus. — Aromatic spirit of ammonia. 
Solution of carbonate of ammonia and aqua ammonias, oils of lemon, 
pimento, and lavender, in alcohol and water. Dose, 3 ss — 3 ij. 

Linimentum Ammonim. — Liniment of ammonia. Cotton-seed-oil 
and aqua ammonise (30 parts to 70). 

RaspaiVs Eau Sedatif. — Liquor ammonia?, two ounces ; chloride 
of sodium, two ounces ; camphorated spirits of wine, three drachms ; 
water, thirty-two ounces. (Not official.) 

Antagonists and Incompatibles. — The vegetable and mineral 
acids, acidulous salts, earthy salts, and lime-water, are incompatible 
with the carbonate. In addition to the acids, potash, soda and their 
carbonates, salts of lead, silver, and metallic sulphates, are incompati- 
ble with the solution of the acetate. The persalts of iron, acids, 
and liquor potassa?, are incompatible with the benzoate. Alkalies, 
alkaline earths and their carbonates, and lead and silver salts, are in- 
compatible with the muriate. In the treatment of poisoning by am- 
monia or its carbonate, the vegetable acids should be used to neu- 
tralize the poison, and its irritant action on the mucous membrane 
should be limited as much as possible by the administration of oil and 
demulcents. 

Therapeutically, ammonia is antagonized by veratrum viride, aco- 
nite, digitalis, cold, and other cardiac sedatives. 

Synergists. — The action of ammonia is favored by heat, opium, 
iodine, by the antispasmodics, as valerian, asafoetida, etc., by the diffu- 
sible and aromatic stimulants, as alcohol, ether, etc. The therapeutical 
activity of the iodides and bromides is promoted by combination with 
carbonate of ammonia. 

Physiological Action. — Ammoniacal gas, brought in contact with 



AMMONIUM. 225 

a mucous surface, irritates it ; applied to the eye, it reddens the con- 
junctiva, and causes lachrymation ; applied to the nares, it reddens the 
mucous membrane, produces a sense of heat and burning, and increases 
the secretion of mucus. Inhaled, an overpowering sense of suffocation 
is experienced, and the glottis spasmodically closes. Prolonged contact 
with the air-passages excites violent inflammation. When solution of 
ammonia is swallowed, an active and destructive inflammation of the 
mucous membrane is set up ; the lips, tongue, soft palate, and tonsils 
are swollen, red, and glazed ; the epiglottis, and especially the arytseno- 
epiglottidean folds, become oedematous, and sudden death may ensue 
from oedema of the glottis. Inflammation of the oesophagus, and of a 
limited portion of the stomach, will also follow the introduction of any 
portion of the irritant. Narrowing (stenosis) of the pyloric orifice has 
been noted, in one case, as an after-result of the inflammation set up in 
this part. In the stomach, ammonia and its carbonate must quickly 
combine with the acid, and probably enter the blood in such combina- 
tion. Increased action of the heart is produced by its administration by 
the stomach, but much more decidedly when it is thrown directly into 
a vein. After the intra- venous injection of ammonia, the blood-pressure 
at first rises, then falls below the normal. Resulting, doubtless, from 
the increased action of the heart, and the more rapid circulation of the 
blood, a subjective sensation of warmth throughout the body is expe- 
rienced, the face becomes flushed, the eyes are more brilliant, and the 
mental operations increase in activity. Little is known of the behavior 
of ammonia in the blood, which in the normal state contains this gas. 
Although it is now known that the coagulation of the blood is not 
caused by the escape of ammonia, as supposed at one time by Richard- 
son, yet ammonia helps to maintain the fluidity of the blood, as its 
presence, in suflicient quantity, certainly serves to hold the fibrin in 
solution. 

The long-continued use of ammonia impairs digestion, by neutraliz- 
ing the gastric juice. Increased waste of tissue is also one result of its 
administration, manifested by pallor, emaciation, and feebleness. When 
introduced into the blood in sufficient quantity, it damages the structure 
of the reel blood-globules, and in this way also it affects the nutrition 
of the body, besides the action which it has, in common with the other 
alkalies, of increasing the rate of waste or retrograde metamorphosis. 

The summary of the physiological actions of ammonia, above given, 
pretty fairly represents the movement of these agents as a group ; but 
individual differences undoubtedly exist, which will be pointed out 
when the therapy is considered. 

Therapy. — Ammonia and its carbonate are sometimes used to 
diminish acidity of the stomach- juices. Obstinate vomiting, after irri- 
tating substances are removed, and when the vomited matters are acid, 
may be relieved by the use of the carbonate, or better, by an excess of 
16 



2'26 AGENTS INCREASING WASTE. 

carbonate in solution of the acetate. The acidity, gaseous eructations, 
and abdominal distention, which accompany attacks of hysteria in some 
females, may be quickly removed by the aromatic spirit of ammonia. 
Nervous headache, especially when it is present with the last-mentioned 
group of symptoms, is speedily relieved by the aromatic spirits and the 
carbonate ; but true migraine, although these preparations of ammonia 
may palliate it, is generally more certainly relieved by the bromides. 
Raspail's eau sedatif often gives great comfort in headache, when 
locally applied. 

In gastric and intestinal catarrh, chloride of ammonium is held in 
high repute by our German confreres. It is certainly highly serviceable 
in some hepatic disorders — for example, in catarrh of the bile-ducts and 
in the jaundice arising from this cause. In the first stage of cirrhosis, 
before contraction and induration have occurred, it is also useful. The 
nauseous saline taste of the sal-ammoniac is best covered by fluid ex- 
tract of taraxacum or extract of liquorice. The fluid extract of tarax- 
acum is to be preferred as the vehicle in hepatic disorders, because 
this drug has reputed virtues in these cases. When there is deficiency 
of secretion of the intestinal juices, constipation, and a coated tongue, 
with scanty and high-colored urine (so-called bilious state), sal-ammo- 
niac is one of the remedies which may be used with success. That 
this drug has a selective action on the liver seems probable from the 
fact that it increases the excretion of urea by the kidneys. 

To stimidate the action of the heart when it flags, the ammonia prep- 
arations have an undoubted effect ; hence in adynamic states they are 
frequently used. When employed for this purpose, small doses fre- 
quently repeated (every half-hour or hour) are necessary, owing to 
the fact that ammonia is quickly eliminated. It is a most common 
practice to inhale ammonia to prevent that depression of the heart's 
action called fainting. It should not be forgotten that ammonia, in- 
cautiously inhaled, may give rise to inflammation of the fauces and 
glottis. The preparations of ammonia (spirits, carbonate, water of) 
possess a high degree of utility when thrombosis is actually existent, 
but especially when threatened, as in the puerperal state, after free 
hcemorrhage, when the circulation is languid from weak heart, a state 
of hyperinosis being present. It is perfectly safe and legitimate under 
these circumstances to practice the intra-venous injection of aqua am- 
moniae, 3 j — 3 ij, diluted with an equal measure of water. This practice 
seems more particularly advisable when sudden thrombosis of a large 
venous trunk ensues — as, for example, in the pulmonary artery, after 
uterine haemorrhage. 

As ammonia has the property to dissolve fibrin, and as its presence 
in the blood contributes to maintain the solubility of its solid and 
morphotic constituents, the intravenous injection, if timely, may suc- 
ceed in redissolving thrombi, but, as direct contact is necessary, no 



AMMONIUM. 227 

other mode of administration can be substituted. When thrombosis 
occurs after post-partum haemorrhage, the promptest action is neces- 
sary ; hence the obstetrician should go provided with the materials 
required. 

In sudden paralysis of the heart from poisonous gases, snake-bites, 
chloroform narcosis, etc., the intravenous injection of ammonia is a 
promising expedient. A remarkable example of the power and utility 
of the practice was published by Dr. J. T. Eskridge, of Philadelphia, 
in 1883. As the author had. personal knowledge of all the circum- 
stances, he can testify to the truth of the narrative. In a case of sud- 
den and most profound depression of the powers of life caused by the 
gases of a privy-vault, and which must have proved fatal if relief had 
not been given, Dr. Eskridge practiced twelve intravenous injections 
of what was supposed to be diluted aqua ammoniaz, but on subsequent 
examination proved to be aqua ammoniaz fortior. The whole amount 
thrown into the circulation was 140 minims, and a vein in front of the 
elbow was the point of entrance of the fluid, the usual precautions 
being taken to prevent accident. No ill result occurring, and the 
patient saved from inevitable death, make this case in the highest 
degree instructive. Although Brunton and Fayrer have pronounced 
adversely to the method when used in the bites of the venomous 
snakes of India, it appears to have been successful in the hands of its 
discoverer, Halford, of Australia, against those of that part of the 
world. It appears to me to be probable, in view of the experience of 
Eskridge, that the failures above referred to were a consequence of 
insufficient quantity of the ammonia. In failure of the heart during 
chloroform narcosis, the intravenous injection of ammonia has not 
succeeded. The reason for this is to be found in the condition of 
the heart. As a rule, the heart stops suddenly and completely, and 
hence, before the injection can be practiced, the cardiac ganglia have 
ceased entirely to functionate. Other medicinal agents, as hydrocy- 
anic acid, nicotine, etc., in toxic quantity paralyzing the heart, cause 
a complex of conditions for the relief of which the ammonia injections 
may be employed. 

The mode of procedure consists in completely filling the syringe 
with the solution so that no air is contained in the instrument, or, if 
the quantity is insufficient to occupy the whole space, to exclude the 
air by a movement of the piston ; then any vein conveniently situ- 
ated for the purpose, and large enough, is selected, steadied between 
two fingers of the left hand, with the right hand the needle is plunged 
into the interior of the vein, and the solution is slowly forced into the 
blood-current. When the needle is withdrawn, light pressure with the 
finger suffices to prevent the escape of any blood. The repetition of 
the injection will depend on the effects, and the limit to the amount 
used will be determined by the state of the heart. 



228 AGENTS INCREASING WASTE. 

Ammonia is a physiological antagonist to hydrocyanic acid, and 
is used in poisoning by this agent ; it counterbalances the depres- 
sion, and maintains the heart's action, until the effects of the poison 
are spent. 

Carbonate of ammonia is one of the remedies occasionally success- 
ful in the treatment of delirium tremens. It is indicated, and proves 
most serviceable, when there is present anaemia of the brain, and the 
heart's action is feeble. Half-ounce doses of solution of ammonia ace- 
tate are said to remove the effects of alcoholic intoxication. The vale- 
rianate of ammonia and the aromatic spirits of ammonia abort or 
prevent paroxysms of hysteria. Nervous headache and also migraine 
may sometimes be cured by the various preparations of ammonia ; but 
of these the muriate is exceptionally serviceable. Indeed, Dr. Anstie 
affirms that this agent, if given early enough, seldom fails to cut short 
an attack of migraine. It should be administered in doses of from ten 
to twenty grains. In myalgia, or muscular neuralgia, it is equally 
effective, according to the same authority : £jk Ammonii choridi, 3 ss; 
ext. ciruicifugse fluidi, 3 j ; glycerini, § ij ; syrupi tolu, aquae lauro- 
cerasi, aa J j. M. Sig. : A teaspoonful three or four times a day. 
In other neuralgiae the muriate of ammonia is occasionally useful, but 
by no means so curative as in migraine and myalgia. 

The preparations of ammonia are classed with the stimulant expec- 
torants. It is an interesting fact, in this connection, that they are elimi- 
nated largely by the lungs ; and it is probable, indeed, that in thus 
escaping they stimulate secretion and liquefy the products of inflamma- 
tion. In bronchorrhcea and chronic bronchitis, muriate of ammonia 
renders important service. It is given in extemporaneous prescriptions 
with extract of liquorice, and may be combined with other stimulating 
expectorants when no incompatibility exists : I> Ext. eucalypt., fl 3 j ; 
ammonii chloridi, 3 ij ; ext. glycyrrhiza?, 3 ij ; glycerini, § iij. M. 
Sig. : A teaspoonful four or six times a day. When great depression 
exists in pneumonia, carbonate of ammonia is given with advantage. 
It should be remembered that to stimulate the heart merely, when 
an obstacle exists in the pulmonary circulation, is of doubtful utility ; 
but ammonia liquefies the exudation, and thus removes obstruction 
of the air-sacs ; hence it becomes a remedy of great value during this 
stage up to the period of crisis. "When there is much adynamia in 
these various pulmonary inflammations, the carbonate of ammonia is 
frequently prescribed in infusion of senega, a stimulating expectorant. 

Extraordinary success has been claimed for carbonate of ammonia 
in variola, scarlatina, rubeola, and erysipelas. A convenient mode of 
administration is to dissolve the carbonate in the solution of the ace- 
tate. The indications for the use of the carbonate ' are, feeble circula- 
tion, cyanosis, delirium. As these are self-limited diseases, the mild 
cases do quite as well without drugs. 



BARIUM. 229 

Carbonate and acetate of ammonia are much prescribed in continued 
fevers — the latter as a so-called febrifuge ; the former when decided 
adynamia ensues. In typhoid the diarrhoea may be increased by the 
solution of the acetate. As in typhus and typhoid the ammonia in the 
blood is increased above the normal, it has seemed to the author im- 
proper practice to administer ammonia as a remedy in these diseases, 
and his observations have convinced him that it has no good effects 
which can not be better procured by other means. 

The chloride of ammonium is said to be an excellent emmenagogue 
in from ten to twenty grains. 

Local Uses of Ammonia. — Ammoniacal gas, cautiously inhaled, 
sometimes gives relief to acute catarrh, and in hay-asthma. Its good 
effects are limited, however, to that stadium of these maladies in which 
the morbid action is confined to the nasal passages, and the discharge 
is yet serous rather than purulent. The pain and smarting which 
attend the stings of insects are alleviated by the application of diluted 
aqua ammonise. The strong aqua ammonise should be at once applied 
to the bite of venomous serpents, and of rabid animals. 

Ammonia is frequently employed as a counter-irritant in the form 
of the well-known volatile liniment. As a vesicant it is also used when 
a prompt action is desired, but it is rather uncertain. 

A solution of sal-ammoniac in alcohol and water is an excellent dis- 
cutient application in inflammatory swellings : Ijk Ammonii chloridi, 
3 ij ; spts. vini rectif., aquae, aa f ij. M. Sig. : Lotion. Cloths moist- 
ened with the solution can be frequently applied, and the cases in 
which it is applicable are the following : Orchitis, inflamed joints, 
sprains, and local and external inflammations generally. 

Authorities referred to : 

Anstie, Dr. F. E. On Muriate of Ammonia as a Remedy for some Nervous Disorders-. 
The Practitioner, vol. i, p. 356. Ibid., vol. xi, p. 318. 

Ibid. Neuralgia and its Counterfeits, pp. 190, 232. 

Bellini, Dr. Ranieri. The Action of Ammonia and its Preparations. British Medv 
cal Journal, 1874, p. 415. 

Brunton and Fayrer, Drs. Proceedings of the Royal Society, No. 149, 1874, p. 132. 

Eskridge, Dr. J. T. The Philadelphia Medical Times, 1883. 

Koehler, Dr. Hermann. Handbuch der physiologische Therapeutik und Materia 
Medica, erste Halfte, Gottingerj, 1875, p. 229, Ammonii preparata. 

Lange, Dr. Archiv fur expcrimentelle Pathologic und Pharmakologie, 1874, p. 225. 
The action of ammonia on the human organism. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 540. 

Stevenson, Dr. Thomas. Guy's Hospital Reports, Series III, vol. xvii, p. 225. Poi- 
soning by liquor ammonia*. 

BARIUM AND ITS PREPARATIONS. 
JBarii Chloridum. — Chloride of barium. Occurs in colorless, 
translucent tablets. It is soluble in diluted alcohol, and freely and en- 
tirely soluble in water. Dose, gr. y 1 ^ — gr. ss. It may be administered 



230 AGENTS INCREASING WASTE. 

in pill form, or in solution, when it should be given well diluted with 
water. 

Antagonists and Incompatibles. — Sulphates, phosphates, and 
carbonates, and most of the salts of organic acids, are incompatible 
with it. Nitrate of silver decomposes it. When it is prescribed, it 
were better to avoid combinations, owing to the numerous incompati- 
bilities to which it is subject. The sulphates are ready antidotes, as 
sulphates of magnesium or sodium. 

Synergists. — The alkalies, and metallic salts from the therapeu- 
tical stand-point, increase its action on the retrograde metamorpho- 
sis. Ergot and digitalis favor its influence over the sympathetic 
system. 

Physiological Actions. — The soluble salts of barium have a disa- 
greeable, bitter, and astringent taste. In a full medicinal dose irrita- 
tion of the stomach is caused, and a sense of heat and burning is 
developed at the epigastrium. In one case (Ferguson) symptoms of 
poisoning came on in a week, produced by one twelfth of a grain of 
chloride of barium, administered three times a day, the whole amount 
taken being two and a half grains. The symptoms were extreme ex- 
haustion and nervousness. An idiosyncrasy must have existed here, 
as so small an amount would not, under ordinary circumstances, have 
produced such decided effects. The usual symptoms in cases of poi- 
soning are intense anguish, free salivation, great thirst, loss of voice, 
violent vomiting and purging, dilated pupils, frequent micturition, 
respiration slow and labored, pulse slow, increasing weakness, and 
finally complete paralysis of the extremities. The intelligence is pre- 
served until near the end, when convulsions and coma come on. The 
post-mortem rigidity is very decided. There are present very con- 
siderable bronchial effusion and hyperemia of the lungs, the heart is 
distended with black blood, and the brain is engorged. The stomach 
presents the usual appearances ; there is intense hyperemia, and 
sometimes perforation of this organ. The quantity necessary to cause 
death varies greatly — two and a half grains have brought on serious 
symptoms, and half a teacupful of the carbonate has been recovered 
from. One drachm of the chloride has caused death in seventeen 
hours, and one ounce of the same salt in one hour (Woodman and 
Tidy). 

The effects on animals have been studied by Onsum, Cyon, Bohm, 
and myself (unpublished). Onsum held that the symptoms produced 
by the soluble salts of barium, when injected into the blood, were due 
to the formation of the insoluble sulphate. Cyon criticises this view, 
and shows that it is incorrect. The most elaborate, as it is the most 
recent, account of the physiological effects of the barium salts is that 
of Bohm. The statement to follow is based on this paper chiefly, and 
on the author's personal researches. In frogs, after injection of the 



BARIUM. 231 

chloride into the lymph-sac, extension and rigidity of the voluntary 
muscles ensued, followed by relaxation and paresis. The belly becomes 
distended and the intestines are thrown into active movements ; the 
mouth is held wide open and a watery fluid continually escapes, while 
from the skin a mucus-like secretion exudes. When given to warm- 
blooded animals by the stomach, profuse secretion takes place, active 
peristalsis of the bowels and copious alvine discharges, and free urina- 
tion follow, but not until about a half -hour after the ingestion of the 
poison. If thrown into the veins the same symptoms arise immedi- 
ately : in either case the tonic and clonic convulsions followed by 
paralysis occur ; the pupils dilate ; the heart is slowed, but its contrac- 
tion is more energetic ; the tension increases enormously in the arte- 
rial system after a preliminary fall, and finally insensibility and coma 
terminate the action. Very large doses, suddenly precipitated on the 
heart by injection into the jugular vein, will induce paralysis both of 
the heart and lungs. With the peripheral paralysis labored breathing 
ensues, due to paresis of the respiratory muscles, and death is caused 
rather by this than by cessation of the heart's action, when the poison 
is introduced subcutaneously. The paralysis in animals begins in the 
hind extremities. This paralysis is preceded by fibrillary trembling 
and clonic spasms mixed with tonic rigidity. The muscular contrac- 
tility is entirely abolished when the paralysis is complete. On the 
nervous system of organic life barium chloride acts as a stimulant. 
The strong cardiac contractions, the dilated pupil, the energetic peris- 
talsis of the bowels, the closure of the lumen of the intestines and also 
of the bladder, and the almost complete approximation of the periph- 
eral vessel-walls, are the proofs of this excitation. 

Therapy. — Influenced by the observations of Bohm, Dr. Flint, of 
Leeds, England, has employed the chloride of barium successfully in 
the treatment of aneurism. The case was one of abdominal aneurism, 
in a woman of sixty-five. Tufn ell's treatment had been carried out 
faithfully for five months without success, and iodide of potassium, 
for some unexplained reason, could not be taken. Chloride of barium 
was, after careful consideration, selected, and one fifth of a grain three 
times a day was administered three or four weeks, when it was in- 
creased to two fifths. The curative effect was very manifest, for after 
nearly five months of continued use of the same remedy the tumor was 
so reduced that it could be scarcely felt. Several similar cases have 
since been reported. Chloride of barium has proved very useful in 
haemorrhage, in acute congestion of organs, in atony of the intestines 
with deficient secretions, in atony of the bladder, in weakness of the 
heart with low arterial tension, in effecting removal of inflammatory 
exudates, etc. In the last-mentioned condition, especially, has the 
author used chloride of barium with excellent effect. 



232 AGENTS INCREASING WASTE. 



VEGETABLE ACIDS. 

Acidum Aceticum. — Acetic acid. Liquid ; specific gravity 1*048. 
Colorless, having a pungent and characteristic odor. Of this acid one 
hundred grains neutralize sixty grains of bicarbonate of potassium. 

Acidum Aceticum Dilntum. — Diluted acetic acid. Seventeen 
parts of the acid to eighty-three parts of water. 

Acidum Aceticum Glaciale. — Glacial acetic acid. Kearly or quite 
absolute acetic acid. At or below 59° F., a crystalline solid. 

Acidum Citricum. — Citric acid. In colorless crystals, freely solu- 
ble in water and soluble in alcohol. One hundred grains of citric acid 
neutralize one hundred and fifty grains of carbonate of potassium. 

Syi'upus Acidi Citrici. — Citric acid, eight parts ; water, eight 
parts ; spirit of lemon, four parts, and nine hundred and eighty parts 
of sirup. 

Acidum Tartaricum. — Tartaric acid. In colorless crystals, wholly 
or almost wholly dissipated by heat, and readily soluble in water. 
One hundred grains of tartaric acid saturate one hundred and thirty- 
three and a half grains of bicarbonate of potassium. 

Antagonists and Incompatibles, — The alkalies are the chemical 
antagonists. 

Synergists. — The alkalies and agents promoting waste favor the 
therapeutical actions of the vegetable acids. 

Physiological Actions. — The vegetable acids, undiluted, have a 
sharp, pungent, and rather acrid taste ; but, when considerably diluted, 
they are rather agreeable and refreshing. They have the property to 
diminish the sense of thirst, to abate heat and the restlessness of fever. 
In large quantity, they possess considerable caustic power, producing 
gastro-enteritis and its results. 

There can be no doubt that these acids obey the chemical laws of 
combination, and unite with alkalies to form salts, in which form they 
enter the blood. The most important question connected with the 
physiological action of these agents is, the disposition of them in the 
blood. The most recent and elaborate examination of this point is the 
" Memoir " of Friedrich Walter. This research appears to have deter- 
mined that these acids do not have the power to neutralize the alka- 
linity of the blood, as has heretofore been supposed. That they are 
in part destroyed in the organism by the ozonizing action of the blood, 
seems undoubted. Carbonic acid is one of the products, and the pres- 
ence of this, we may assume, accounts for the increased acidity of 
the blood and of the urine which follows the administration of these 
agents. 

They are eliminated by the intestinal canal, and chiefly by the kid- 
neys. They increase secretion from the intestinal mucous membrane, 



VEGETABLE ACIDS. 233 

and are apt to produce tormina, flatulence, and diarrhoea. It is proba- 
ble that these intestinal effects are in part due to the fact that the salts, 
formed by combination of the acids in the canal, escape absorption and 
act locally as they descend. 

These acids, or the salts formed by their combination, have a de- 
cided power to promote diuresis. In this result all of the urinary con- 
stituents are included ; but it is chiefly the water which is increased. 
To these general statements some exceptions must be made. Thus, 
citric and acetic acids are entirely destroyed in their passage through 
the organism ; benzoic acid is converted into hippuric ; and tartaric, 
citric, and malic are converted into carbonic after combination with 
alkali only. Furthermore, benzoic acid does not increase any of the 
urinary constituents. 

Ultimately, wasting and emaciation, a watery condition of the 
blood, and a scorbutic state (Bence Jones), are the results of the 
action of these agents. 

Theeapy. — Acetic acid applied to the skin has some superficial 
caustic property. This is made use of to cure small warts and vegeta- 
tions of the skin. It is applied with a pine stick. Parasitic affec- 
tions of the skin are similarly treated, as, for example, pityriasis. 

Internally the acids, chiefly citric, in the form of lemonade, are used 
as a refreshing drink in fevers. They allay restlessness by relieving 
thirst, and they also act upon the skin and kidneys. Lime-juice is 
the most important antiscorbutic, and constitutes part of the equip- 
ment of every vessel on long voyages. It should not be forgotten 
that the use of lemon-juice may cause precipitation of uric acid, and 
thus favor the formation of calculi, as has been pointed out by Bence 
Jones. 

Lemon-juice was at one time the fashion in the treatment of acute 
rheumatism ; but more efficient remedies have taken its place. 

Acids are serviceable in various disorders of the digestive tract ; 
given before meals, they check the formation of acid, and thus re- 
lieve acidity. An acid and dry wine — as, for example, a Rhenish 
wine — may sometimes serve a useful purpose. The juice of a lemon 
may be taken before meals with the same object. But it is true that 
the mineral acids are to be preferred for this purpose. Very injurious 
effects are produced by the long-continued use of lemon-juice in such 
cases. It is sometimes taken by young ladies to keep down the for- 
mation of fat ; but it accomplishes this object by impairing digestion. 

Authorities referred to : 

Jones, Dr. H. Bence. Lectures on Materia Mediea. The Medical Times and Gazette, 
October, 1854, p. 408. 

Parkes, Dr. E. A. On the Urine, 1860, p. 146. 

Walter, Friedrich. Untersuchungen uber die Wirkung der Sauren auf den thierisch* 
en Organismus. Archiv f. expcr. Pathol, u. Phar., 18V7, p. 148. 



•234 AGENTS INCREASING WASTE. 



SULPHUROUS ACID AND THE SULPHITES. 

Acidum Sulphurosum. — Sulphurous acid. A colorless liquid, hav- 
ing the odor of burning sulphur, and a sulphurous, sour, and somewhat 
astringent taste. Dose, tti v — 3 j. 

Sodii JETyposulphis. — Hyposulphite of sodium. In large, colorless, 
transparent crystals, having a bitter, slightly alkaline, and sulphurous 
taste. It is soluble in one and a half part of water at 60°, and insolu- 
ble in alcohol. Dose, grs. v — 3j. 

/Sodii Sulphis. — Sulphite of sodium. In white, efflorescent, pris- 
matic crystals, soluble in four parts of cold and in less than one part 
of boiling water. It has a sulphurous taste, and a feeble alkaline reac- 
tion. Dose, grs. v — 3j. 

Sodii Bisulphis. — Bisulphite of sodium. Opaque, prismatic crys- 
tals, or a crystalline or granular powder, slowly oxidized and losing 
sulphurous acid on exposure to air, having a faint sulphurous odor and 
taste, and an acid reaction ; soluble in four parts of water at 60° Fahr., 
and in two parts of boiling water. Dose, grs. iij — grs. x. 

Potassii Sidphis. — Sulphite of potassium. In white, opaque frag- 
ments or powder, very soluble in water. It has a saline and sulphurous 
taste. Dose, grs. iij — grs. x. 

Magnesii Sutyhis. — Sulphite of magnesium. " A white, crystalline 
powder, gradually becoming oxidized on exposure to air, odorless, 
having a slightly bitter, somewhat sulphurous taste, and a neutral or 
slightly alkaline reaction." It is insoluble in alcohol but is soluble in 
twenty parts of water at 60° Fahr. Dose, grs. v — 3j. 

Antagonists and Incompatibles. — The mineral acids — including 
sulphuric — decompose the sulphites and hyposulphites. All oxidizing 
substances are incompatible. These preparations have a great affinity 
for oxygen, and the sulphites readily become sulphates. 

Synergists. — All remedial agents which arrest fermentative pro- 
cesses promote the therapeutical activity of sulphurous acid and the 
sulphites. 

Physiological Actions. — Sulphurous acid is a disinfectant and de- 
odorizer. It attacks organic matter with energy, by virtue of its affinity 
for oxygen. It is very destructive to the lower forms of life, bacteria, 
fungi, etc. Sulphurous-acid gas inspired produces great irritation of 
the glottis, and an intensely suffocative feeling. In sufficient quantity 
it produces violent inflammation of the air-passages. As by combina- 
tion with oxygen sulphuric acid is formed, the destructive effect as- 
cribed to sulphurous acid is in reality chiefly due to sulphuric. 

The sulphites exposed to the air rapidly absorb oxygen, and pass to 
the state of sulphates. The hyposulphites are more constant than the 
sulphites. In the stomach, by the acid of the gastric juice, these salts 
are in part decomposed and sulphurous acid is given off ; in part they 



SULPHUKOUS ACID. 235 

are converted into sulphates. They are undoubtedly absorbed as sul- 
phates, and are eliminated partly by the intestinal canal, but chiefly 
by the kidneys, as sulphates. The author demonstrated these facts 
soon after the publications of Dr. Polli led to an enthusiastic adminis- 
tration of these remedies in the zymotic diseases. 

Therapy. — Dilute sulphurous acid is one of the numerous local ap- 
plications considered efficacious in mercurial stomatitis, aphthae, mucous 
patches, ulcers of the tonsils, and in diphtheria. In all of these affections 
the diluted acid may be applied directly to the diseased surface by a 
mop, a sponge-probang, or in the form of spray. A more easily managed 
application is a solution of the sulphite of soda ( 3 j — f j in water). 

In certain kinds of vomiting of a yeast-like material, especially when 
sarcina are present in the vomited matters, the sulphites are often 
curative. Vomiting of acid matters, pyrosis, and indigestion, due to 
acid fermentation of the starchy and saccharine elements of the food, 
are relieved by sulphurous acid {y\ v — 3 j, well diluted), or, but less 
efficiently, by sulphite of soda (3j — 3 j). The result in these cases 
is, no doubt, due to the power which sulphurous acid has of arresting 
the fermentation processes. 

Sulphurous acid has been utilized of late in the treatment of 
phthisis, by rectal injection and by inhalation. A reaction has already 
begun against the use of the rectal injections — for they are trouble- 
some to execute, and after a while the rectum becomes irritable. In- 
halation of the gases, however, is increasing in favor. Dr. De war's 
warm advocacy of sulphurous acid was never tested in its results to 
any extent. Now, however, it is seen that his mode of treatment has 
much to recommend it, and was then in advance of his time. More 
effective, the author finds, is the " Pictet liquid " — which consists of 
sulphurous-acid gas and carbonic-acid gas liquefied by pressure and 
kept in siphon-bottles. A small quantity of this can be given out in 
the air of the apartment occupied by the patient. Care must be used 
to rightly gauge the quantity to the susceptibility of the patient. 

Sulphurous-acid spray is a good local application in syphilitic and 
tubercitlous laryngitis. Cases of chronic bronchitis, with profuse expec- 
toration of a fetid character (bronchorrhcea), are sometimes improved 
by inhalations of sulphurous-acid gas, or of the acid in the form of spray. 

Externally applied, sulphurous acid and the hyposulphites and sul- 
phites are in some maladies extremely serviceable. 

As a disinfectant and deodorizer sulphurous acid is at the same time 
efficient, easily managed, and economical. Sulphurous acid is the prod- 
uct of the combustion of sulphur in the open air ; hence, to disinfect 
rooms, it is necessary only to close all egress and fill them with the 
fumes of burning sulphur. It is to be remembered that sulphurous 
acid is injurious to many fabrics. The sulphites are colorless and soluble. 

Sulphurous acid is an efficient application to chilblains : $ Acid. 



•230 AGENTS INCREASING WASTE. 

sulphurosi, 3 iij ; glycerini, 3 j ; aquae, 3 jss. M. In parasitic skin-dis- 
cascs, the sulphites, hyposulphites, and sulphurous acid are used to 
destroy the parasites. The following formula is employed by Startin 
in these affections : I£ Sodii hyposulphitis, 3 iij ; acid, sulphurosi dil., 
3 ss ; aquae, q. s. ad 3 xvj. Fox recommends the following formula in 
tinea versicolor and in pruritus vulvce : ^ Sodii hyposulphitis, 3 iv ; 
glycerini, 3 ij ; aqua? destil. ad f vj. 

Sulphurous acid is an excellent application \>o ill-conditioned, slough- 
ing, or gangrenoiLS wounds. It was very successful in these cases, at 
the English hospital at Metz, during the Franco-German War. 

Authorities referred to : 

Bartholow, Dr. Roberts. TJie Lancet and Observer, Cincinnati, 1865. 

Bird, Dr. Robert. The Practitioner, vol. ii, p. 247. 

Braux and Bernatzik, Profs. Wiener med. Wochenschrift, Nos. 94-99, 1869. 

Detvar, Dr. James. On the Application of Sulphurous-Acid Gas to the Prevention, 
Limitation, and Cure of Contagious Diseases, Edinburgh, 1866. 

Drysdale, Dr. Charles R. The Lancet, July 24, 1869. 

Fergus, Mr. The Lancet, November 26, 1860. 

Fox, Dr. Tilbury. Skin Diseases, New York, 1873. 

Miller, Dr. Edinburgh MedicalJournal, September, 1869. 

Polli, Prof. Various Papers. Abstracts in Schmidt's Jahrbucher der gesammten 
Medicin, etc., for 1864, '65, '66, to 1870. 

Purdon, Dr. H. S. British Medical Journal, May 9, 1868. 

Sulphur and Sulphides (Sulphurets). — Potassa Sulphurata. Sul- 
phurated potassa has a brownish-yellow color when freshly broken. 
It dissolves in water, with the exception of a slight residue, and forms 
an orange-yellow solution, which exhales the odor of hydrosulphuric 
acid. Dose, gr. j — gr. v. 

Calx Sulphurata. — Sulphurated lime. A greenish-gray powder, 
having a strong odor of sulphureted hydrogen. Dose, gr. j — gr. v. 

Antagonists and Incompatibles. — Solutions of the sulphides are 
decomposed by the mineral acids, sulphureted hydrogen being liber- 
ated and sulphur precipitated. Solutions of the metals, generally, are 
also incompatible with the sulphides of potassium and calcium, for, in 
the decomposition which ensues, the metals are precipitated in the form 
of insoluble sulphides. Hence it is that these preparations have been 
proposed as antidotes to the metallic poisons. Chlorine-water, chlo- 
rides of sodium and potassium, sulphate of iron, etc., are chemical 
antidotes. 

Synergists. — All agents promoting waste are, therapeutically con- 
sidered, synergistic. Alkalies favor their action, both chemically and 
physiologically. 

Physiological Actions. — These preparations have a decidedly nau- 
seous taste and smell, and are somewhat irritant. In the stomach they 
excite a sense of heat, and in sufficient quantity cause gastro-enteritis, 
with all the attendant symptoms belonging to irritant poisons. Dis- 



SULPHIDES. 237 

agreeable eructations of sulphureted hydrogen take place when they 
are administered medicinally, owing to the reactions in the presence 
of an acid alluded to above. They stimulate the secretion of the gas- 
trointestinal canal, and are laxative. The fetor of the stools is in- 
creased by their use, a result not altogether due to the evolved sul- 
phureted hydrogen, but to the increased action of those intestinal 
glands concerned in elimination. As the sulphides pass easily to the 
state of sulphates by the action of oxygen, it may be assumed that a 
part of their physiological effects is produced by the latter salts. 
They, however, undoubtedly exercise a toxic action on the blood, im- 
pairing the red blood-globules, and increasing the amount of effete 
material. Emaciation, muscular weakness, and trembling, and a feeble 
circulation, are results of their use in large amount, or for lengthened 
periods. It is true that some acceleration of the pulse-rate and in- 
crease of secretion of the mucous surfaces follow their medicinal ad- 
ministration for a short period and in moderate doses ; but the pro- 
longed inhalation of sulphureted hydrogen, or the prolonged internal 
use of the sulphides, causes great anaemia, wasting, and debility. 

Therapy. — The waters of the well-known Blue Lick Springs, and 
others, of Kentucky, which are almost identical in composition with 
the famous Harrogate, of England, may be substituted for the sul- 
phides in many of the cases in which the latter are useful. 

The Blue Lick waters are useful in abdominal plethora. A pint 
taken before breakfast is an efficient laxative, which is indicated in 
cases of habitual constipation from deficient secretion of the intes- 
tinal juices. Four ounces taken before each meal is an excellent 
remedy for obesity. Engorgement of the pelvic viscera in women, and 
haemorrhoids in both sexes, when due to torpor of the portal circula- 
tion, are relieved by the same agent. For these purposes the Blue 
Lick waters may be taken for several weeks or even months, but their 
use should be discontinued when anaemia is threatened. In anaemic 
subjects, chalybeates and a generous diet should be conjointly ad- 
ministered. The author has observed excellent results from the pro- 
longed use of this water in glandular affections, hepatic, splenic, uter- 
ine, and of the prostate. 

A succession of common boils, scrofulous and other abscesses, are, 
it is said, made to mature, and the expulsion of the pus is favored by 
the use of the sulphides. When abscesses are threatened, and before 
matter is formed, the sulphides, it is claimed, may cause them to abort. 
Small doses (gr. ss — gr. j) frequently repeated (every hour or two) are 
said to be most effective under these circumstances. Since the publi- 
cation of the last edition of this work, rectal injection of gases ob- 
tained from natural waters corresponding in composition to the Ken- 
tucky Blue Lick has been brought forward. A century ago Priestley 
and others advocated this expedient, but the method did not appeal 



238 AGENTS INCREASING WASTE. 

to the practical talent of the profession, and hence fell into complete 
desuetude. Its revival was due to the discovery of Bernard, that 
sulphureted-hydrogen gas and carbonic-acid gas, when thrown into 
the rectum, escape quickly from the lungs, and hence do not reach the 
nerve-centers. In passing through the lungs, morbid processes, mor- 
bific germs, etc., are acted on by the gas. The discovery of the 
bacillus tuberculosis was the next step, and after this the utilization of 
Bernard's discovery. Already the rectal injection of the gases is being 
superseded by the more direct and facile inhalation of the same agents. 

External Uses of the Sulphides. — A solution of the sulphide of 
potassium ( 3 ss — § j) is an efficient application in scabies. An extem- 
poraneous sulphide may be made by boiling one part of quicklime and 
two parts of sublimed sulphur in ten parts of water. With this solu- 
tion the parts affected by scabies may be painted over, after prelimi- 
nary cleansing with a warm bath. Sulphur-baths (solution of sulphide 
of potassium in water, as above mentioned) are very excellent applica- 
tions in the chronic forms of psoriasis and eczema. The following 
formula is recommended by Fox in scabies and prurigo : $ Potassii 
sulphureti, § vi ; sapon. alb., Ibij ; ol. olivae, Oij ; ol. thy mi, 3 ij. M. 
A milder preparation is the following : ^ Potassii sulphureti, 3 iij ; 
sapon. moll., § j ; aquae calcis, § viij ; alcohol, § ij. M. Or the fol- 
lowing : fy Potassii sulphureti, § ss ; aquae calcis, § xvj. M. For 
the relief of pityriasis and parasitic skin-diseases. 

The sulphide of sodium (unofficial) being more stable, is better 
suited for the preparation of sulphurous baths. An artificial sulphur- 
ous water, in imitation of the Bareges, is made as follows : I£ Sul- 
phidi sodii, sodae, sodii chloridi, aa § ij. M. Sig. : A sufficient quan- 
tity for one bath. The Pommade de Bareges of the French is consti- 
tuted as follows : t> Sodii sulphureti, sodii carbonat., aa 3 ij ; axun- 
giae, § ijss. M. 

Sulphur-baths are frequently employed to favor the elimination of 
lead, in cases of saturnine disease. 

Authorities referred to : 

Fox, Dr. Tilbury. Skin Diseases : Their Description, Pathology, etc., second Ameri- 
can edition. 

Lewis, Louis. The Lancet, March 14, 1874, p. 393. 

Macpherson, Dr. John. The Batlis and Wells of Europe, London, 1873. 

SULPHUROUS MINERAL WATERS. 
1. North America. 
French-Lick Springs. 

West-Baden Springs, Orange County, Indiana. 
Indian Springs, Martin County, Indiana. 

These waters contain carbonates of soda, potassa, magnesia, and 
lime, and chlorides of sodium, potassium, magnesium, and calcium, 



SULPHUROUS WATERS. 239 

and sulphates of soda, magnesia, lime, and potassa. The gases are 
sulphureted hydrogen and carbonic-acid gas. 

Upper Blue-Lick Springs, Nicholas County, Kentucky. 

Lower Blue-Lick Springs, Nicholas County, Kentucky. 

Big-Bone Springs, Boone County, Kentucky. 

Paroquet Springs, Bullitt County, Kentucky. 

These waters are remarkable for the quantity of sulphureted hydro- 
gen which they contain (from 1*02 cubic inch to 3*75). They are rich 
in the chloride of sodium (from 38*700 grains to the pint to 64*567 
grains). They contain also chlorides of potassium, sodium, magnesium, 
and calcium, carbonates of soda, magnesia, iron, and lime, sulphates of 
soda, potassa, and magnesia, and appreciable quantities of iodides and 
bromides. 

Alpena Well, Alpena County, Michigan. 

This water contains the large quantity of 4*42 cubic inches of sul- 
phureted hydrogen to the pint. The proportion of chloride of sodium 
is small (8*532 grains to the pint). The other ingredients are carbon- 
ates of soda, magnesia, iron, and lime, and sulphate of lime. 

Sharon Springs, Schoharie County, New York. 

Avon Springs, Livingston County, New York. 

Mild sulphureted waters. The principal salt is sulphate of lime, 
which is found in the different springs, ranging from 11*687 grains to 
13*95 grains to the pint (Sharon). 

Yellow-Sulphur Springs, Montgomery County, Virginia. 

The most important constituents of these waters are sulphates of 
lime, magnesia, soda, potassa, and alumina, and carbonates of lime, mag- 
nesia, and iron. The gas is carbonic acid and sulphureted hydrogen. 

Greenbrier White-Sulphur Springs, West Virginia. 

Salt-Sulphur Springs, Monroe County, West Virginia. 

Red-Sulphur Springs, Monroe County, West Virginia. 

These springs are nearly alike as respects the composition of their 
waters. They contain chlorides and sulphates, but their principal con- 
stituents are sulphate of lime, sulphate of soda, and sulphate of mag- 
nesia. The Greenbrier Spring and the Red-Sulphur Spring waters 
contain also a peculiar sulphur compound, in regard to the nature of 
which but little is known. 

2. European. 

Harrogate, Yorkshire, England. Season from May to September. 

These waters contain chlorides of calcium, magnesium, potassium, 
and sodium, carbonic-acid gas, and sulphureted hydrogen. 

Llandrindod, Wales. 

Saline, chalybeate, and sulphur waters ; rich in chlorides, especially 
of sodium. 

Strathpeffer, Ross-shire, Scotland. 



240 AGENTS INCREASING WASTE. 

This is a strong sulphureted water, and contains sulphate of lime, 
carbonate of lime, sulphate of magnesia, and sulphate of soda. 

Moffatt, south of Scotland. 

The waters contain chloride of sodium (28*07), sulphate of soda, 
sulphate of lime, and sulphureted-hydrogen gas. 

Bareges, Hautes-Pyrenees. Altitude, 4,000'. Temperature, 86° to 
113° Fahr. Season from July to September. 

"Waters contain sulphide of sodium, sulphate of soda, chloride of 
sodium, etc. 

These waters are used chiefly for bathing the patients, beginning 
with the colder and passing on to the hotter waters. These springs 
have a special celebrity for the treatment of old wounds, diseases of 
bones, and rheumatic and neuralgic affections. 

Cauterets, Hautes-Pyrenees. Altitude, 3,000', but sheltered. Sea- 
son, June to September. Temperature of baths, 98° to 131° Fahr. 

The composition of the waters is similar to that of those of Bareges, 
but it is more stimulating, and contains a good deal of iodine. It is 
especially advised in incipient tuberculosis, bronchial affections, and 
pelvic diseases of women. 

Eaux-Bonnes, Basse-Pyrenees, near Pau. Altitude, 2,000'. 

Waters sulphurous and saline, similar to but not so exciting as those 
of Bareges. This resort is celebrated chiefly for its effects in laryngeal 
diseases and clergyman's sore-throat. 

Challes, Savoy. 

This water, according to Macpherson, is one of the most remarkable 
in Europe, and " is the strongest sulphur-well known." It contains 
iodine and bromine, sulphide of sodium, bromide of sodium, etc. 

Aix-la-Chapelle 9 Rhenish Prussia. Altitude, 450'. Temperature 
of air during season, mean, 63° Fahr. Season from June to Sep- 
tember. 

According to Liebig's analysis, these waters contain chloride of 
sodium (20 grains), bromide, iodide, and sulphate of sodium, carbon- 
ate of soda (4-9 grains), sulphate of soda (2*1 grains), sulphate of 
potash (1*1 grain), and carbonates of lime, magnesia, strontia, lithia, 
etc. Used by drinking and bathing, and especially in cutaneous 
diseases, rheumatism, syphilis, hepatic disorders, etc. 

Eilsen, Lippe-Schomburg, Northern Germany. 

Netmdorf, Prussian Westphalia. 

These waters contain the sulphates of soda, magnesia, lime, and 
chlorides of calcium and magnesium. They are highly charged with 
carbonic-acid gas and sulphureted hydrogen. They are useful in 
gouty and rheumatic affections, syphilis, skin-diseases, etc. 

Schintziiach, Switzerland. Altitude, 1,060'. 

This is a highly-sulphurous water, and is charged with carbonic- 
acid gas and sulphureted hydrogen. It contains sulphate of soda 



IODINE AND IODIDES. 241 

(9.87 grains), sulphates of potash and lime, chlorides of potassium and 
magnesium, and carbonates, etc. 

Therapy of the Sulphur- Waters. — Of the sulphurous waters 
given above, those belonging to this country are quite unsurpassed in 
therapeutical value. As a rule, such waters are useful in liver-dis- 
orders ; they diminish abdominal plethora, and congestion of the 
portal circulation. They are indicated in malarial affections of the 
liver and spleen. Rheumatism and gout, tuberculosis in its incipi- 
ence/, chronic poisoning by the metals, etc., are certainly benefited by 
the internal use, and by baths of sulphurous waters. Affections of 
the skin, syphilitic diseases, chronic rheumatic affections, etc., are 
especially forms of disease remediable by these waters, used internally 
and in the form of baths. 

Authorities referred to : 

Brattn, Dr. Julius. Systematisches Lehrbuch der Balneotherapie. 

Macpherson, Dr. John. Baths and Wells of Europe. 

Moorman, Dr. J. J. Mineral Springs of North America. 

Valentiner, Dr. Th. Handbuch der allgemeinen und speciellen Balneotherapie. 

Walton, Dr. George E. Mineral Springs of the United States and Canada. 

IODINE AND ITS PREPARATIONS. 

Iodum. — lode, Fr. ; lod, Ger. ; Iodinium, Latin. 

Iodum. — Iodine. In bluish-black crystalline scales, having a me- 
tallic luster ; very slightly soluble in water (1 in 7,000) ; soluble in al- 
cohol (1 in 12), in ether, in a solution of iodide of potassium, and in a 
solution of chloride of sodium. Dose, gr. ss — gr. j. 

Iodoformum. — Iodoform. In yellow crystals, having a saffron- 
odor. Insoluble in water, but soluble in ether, and the fixed and 
volatile oils. May be prescribed in a mixture, containing at least 
twenty times its weight of mucilage to render it properly miscible 
with water. Dose, gr. j — grs. v. 

Liquor Iodi Compositus. — Compound solution of iodine. Iodine, 
5 parts ; iodide of potassium, 10 parts ; distilled water, 85 parts. 
Dose, ttx v — ni xx. 

Tinctura Iodi. — Tincture of iodine. Iodine, 8 parts ; alcohol, 92 
parts. Dose, ni j — tt|, v. 

Unguentum Iodi. — Iodine ointment. Iodine, 4 parts ; iodide of 
potassium, 1 part ; water, 2 parts ; and benzoinated lard, 93 parts. 

Unguentum Iodoformi. — Ointment of iodoform. Iodine, 10 parts ; 
benzoinated lard, 90 parts. 

Amylum Iodatum. — Iodine, 5 parts ; starch, 95 parts. Dose, gr. j 
— gr. xv. 

Unguentum Potassii Iodidi. — Ointment of iodide of potassium. 
17 



243 AGENTS INCREASING WASTE. 

Iodide of potassium, 12 parts ; hyposulphite of sodium, 1 part ; boil- 
ing water, 6 parts ; benzoinated lard, 81 parts. 

Amrnonii Iodldum. — Iodide of ammonium. A white, granular, 
very deliquescent salt, becoming yellowish-brown by exposure. Yery 
soluble in water and in aleohol. Dose, grs. ij — grs. x. 

Potassil Iodldum. — Iodide of potassium. In white or transparent 
crystals, wholly soluble in water (4 in 3), and in alcohol (1 in 6). 
Dose, grs. v — 3 j. 

Sodii Iodidum. — Iodide of sodium. In minute crystals, or crystal- 
line powder, deliquescent, having a saline and bitter taste and an alka- 
line reaction. Soluble in water and in alcohol. Dose, grs. ij — 3 j. 

Antagonists and Incompatibles. — Iodine is incompatible with 
the mineral acids, the metallic salts, the vegetable alkaloids, etc. The 
chemical antidote is starch, or substances containing it, as flour. These 
should be given freely diffused in water. It should be remembered 
that starch is the antidote to free iodine. As, however, the iodide of 
starch is not devoid of activity, in cases of poisoning by iodine the 
contents of the stomach should be evacuated. It is obvious that the 
preparations of iodine, taken after a meal consisting of amylaceous 
materials, will have their activity impaired by the formation of the 
iodide of starch, the acid of the stomach freeing the iodine from its 
chemical association. 

Synergists. — Alkalies, and other remedies which increase waste, 
favor the action of iodine and the iodides. Under some circumstances, 
mercurials are especially synergistic. 

Physiological Actions. — Iodine. — When brought into contact 
with albuminous substances, iodine combines with it and prevents 
putrefactive change. The vapor of iodine, like chlorine, but in a fee- 
bler degree, decomposes sulphureted and phosphureted compounds. 
It is, therefore, justly ranked among the disinfectants. 

Applied to the skin or mucous membrane, iodine, according to the 
extent of the application, is irritant or caustic. It stains the skin yel- 
low, causes a sensation of warmth in small quantity, or of burning in 
larger quantity, and excites a superficial inflammation followed by des- 
quamation. In some subjects the application of iodine-paint causes 
vesication. Pure iodine, kept in contact with the tissues, produces a 
brown and dry eschar. The vapor of iodine is very irritant to the 
broncho-pulmonary mucous membrane, causing cough, spasm of the 
glottis, and increased flow of mucus. 

Iodine has a hot, pungent flavor, and excites a sensation of heat or 
burning in the stomach. In sufficient quantity, it acts as an irritant 
poison, inflames the mucous membrane of the stomach, and causes su- 
perficial eschars. The amount of iodine necessary to produce toxic 
symptoms varies greatly, and the variation depends in part on consti- 
tutional peculiarities, but chiefly on the amount and quality of the 



IODINE AND IODIDES. 243 

food in the stomach. Whether applied to the surface of the skin or 
taken into the stomach, it quickly diffuses into the blood, and enters 
into combination with sodium or potassium, or with both. 

Iodides. — The iodides are among the most diffusible substances. 
They have a bitter, saline, and very disagreeable taste. In a few min- 
utes after being swallowed, the taste of iodide of potassium returns in 
the mouth, and, during a course of this salt, the saliva is constantly 
charged with it. In the stomach, in considerable doses, they produce 
first a cooling sensation, followed by warmth, and even burning. 
They pass into the blood with great rapidity. It is said that the base 
is changed in the blood, and the iodides of ammonium and potassium 
become iodide of sodium. In the blood they probably undergo no fur- 
ther changes, and do not, so far as is known, modify the composition 
of that fluid. At the points of elimination from the free mucous sur- 
faces (nasal, faucial, and bronchial mucous membrane), the chemical 
changes which ensue set free ozone, and the irritation there experi- 
enced is probably in part due to the iodine, separated from its combi- 
nations by the action of that agent (Buchheim). Elimination doubt- 
less takes place by the broncho-pulmonary, faucial, and salivary glands, 
but chiefly by the kidneys. The diffusion of the iodides into and out 
of the blood takes place with such rapidity that in fifteen minutes they 
may be detected in the saliva and in the urine. 

Diverse opinions have been expressed in regard to the influence of 
the iodides over the assimilative functions. By the syphilographers it 
is held that the iodides promote constructive metamorphosis, and that 
a gain in body-weight is a result of their use. This opinion is devel- 
oped in this way : The subjects of syphilis in its constitutional form 
emaciate, and their forces are depressed ; but, when the iodides are 
given them, the virus is eliminated, and the organism at once reacts. In 
the physiological state the iodides increase waste and the elimination 
of the products of waste, and emaciation with a general depression of 
the vital functions ensues, when they are administered for lengthened 
periods. 

The proof of the statements just made has been afforded us by the 
researches of Duchesne, who has ascertained that a decided increase in 
the amount of urea excreted results from the action of the iodides, 
especially of the iodide of potassium, and this enhanced metabolism of 
the nitrogenous elements persists for several days after their adminis- 
tration has ceased. Bouchard, so long ago as 1872, had ascertained the 
same fact. The other iodides — of ammonium, sodium, and calcium — 
act in a similar manner during the time of their administration, but 
their subsequent effects are far feebler and shorter in duration. 

The tincture of iodine acts in a manner similar to iodide of potas- 
sium, but it has a more powerful effect in increasing nitrogenous 
waste, as represented in the excretion of urea. An important observa- 



244 AGENTS INCREASING WASTE. 

tion has been made by Duchesne as to the influence of iodine in the 
condition of interstitial nephritis with albuminuria. He notes that 
when increasing doses of the tincture are given, the quantity of albumen 
lessens and finally disappears entirely. As the actions of iodine and 
of its combinations are really so different in character as well as in 
power, it becomes important to ascertain which may be the better 
fitted for particular service. Lasegue had, long ago, empirically ascer- 
tained that tincture of iodine should be preferred to iodide of potas- 
sium, whenever it is necessary to stimulate the retrograde metamor- 
phosis — to increase oxidation, or to enact the part of " alterative." 

lodism. — When the prolonged administration of iodine or iodides 
becomes necessary, certain precautions must be observed to prevent 
the development of ioclism. Especially will such precautions be neces- 
sary when massive doses of iodides are administered through many 
months and years in cases of arterio-sclerosis. Prof. See maintains 
that by occasional intermissions, and the use of eliminants at such 
times, iodism may be prevented. 

Ehrlich, and subsequently Kronig, have ascertained that sulphanilic 
acid has the power to prevent or arrest iodism. The action is a chemi- 
cal one, and is explained thus : the phenomena of iodism are due to 
the presence of free iodine, and this agent is separated from its com- 
binations by the nitrates in the presence of a weak acid. As sulpha- 
nilic acid has a strong affinity for nitric acid, the reaction which frees 
iodine is prevented. 

Atropine is quite effective as a remedy for iodism, by arresting the 
morbid action taking place on the mucous surface, where the recom- 
bination of iodine is taking place (Binz). Some of the rashes, hydroa, 
etc., which belong to iodism, are also removed by atropine. The acne, 
the gastric disturbances, and the depression of the vital powers, are to 
some extent favorably affected by arsenic, and hence, if there be no con- 
traindications, it can be given in the same prescription with the iodides. 
It is iodine, rather than the iodides, when given in large quantity, that 
produces the state termed iodism. The quantity which will set up this 
state of irritation in one subject will affect another but slightly, if at 
all ; in other words, the susceptibility to the iodine impression varies 
greatly in different individuals. Iodism is manifested by general 
malaise and rise of temperature, frontal headache, coryza, lachryma- 
tion, and sometimes inflammatory swelling of the eyelids, a bittter sa- 
line taste in the mouth, soreness of the throat, hoarseness, and difficulty 
of swallowing — phenomena strikingly similar to summer catarrh. In- 
deed, patients who experience these sensations for the first time, sup- 
pose them to be an acute catarrh. Usually the symptoms of iodism 
subside, notwithstanding the dose which caused them may still be 
taken, or, as it may be expressed, a " tolerance " is established. The 
quantity which at one time may have caused violent iodism will not 



IODINE AND IODIDES. 245 

necessarily again do so, although a considerable interval may have 
elapsed. Indeed, it is sometimes difficult to induce iodism in those 
who have become habituated to the use of the iodides in considerable 
medicinal doses. 

An eruption of acne, especially on the face, shoulders, and thighs, is 
a very common result of the internal use of the iodides ; hydroa on 
the face and forehead is an occasional consequence, but eczema is more 
frequent, yet less so than acne, which is usual. 

Wasting of the mammae and of the testes has never been observed 
by the author, although he has used the largest doses of the iodides, 
for long periods. There is no doubt about their antaphrodisiac ef- 
fects, and it has seemed to the author that permanent loss of sexual 
power has resulted from their long-continued use. 

When it is desirable to avoid iodism, large draughts of water should 
be taken during a course of the iodides. As Rosenthal has shown, large 
dilution of the salt hastens elimination, and thus prevents the more 
severe effects of iodism. 

Benedict has experimentally studied the effects of iodine and of 
iodide of potassium on the nervous system. His observations, made 
on frogs, demonstrated that these agents caused paralysis of the heart 
and of the respiration. Schule reports a case in which such symptoms 
were induced by injecting the sac of a spina bifida with tincture of 
iodine, but the direct and reflex effects of the injection on the spinal 
cord may have had much to do with the result. 

Therapy. — The selection of an iodide for internal administration 
is influenced by the type of the individual, by the condition of the 
heart, and by the purpose to be subserved. If an idiosyncrasy to the 
action of an iodide exist, its nature and power should be ascertained. 
When the combinations of iodine with alkaline bases can not be taken, 
iodide of starch — li amylum iodatum " — may be substituted, and, al- 
though not so efficient as a remedy, is far less likely to cause acute 
iodism, or to set up a gastric catarrh. Also, as the salts of potassium 
have a more depressing effect on the heart than the corresponding 
sodium salts, the latter are preferable when long-continued admin- 
istration is required. On the other hand, if the circulation is active 
and the forces unabated, iodide of potassium will prove more effective. 

The vomiting of pregnancy can sometimes be greatly relieved by 
drop-doses, every hour or two, of the tincture of iodine. This, like all 
other remedies for this disorder, is very uncertain, and precise indica- 
tions for its use have not hitherto been ascertained. Catarrh of the 
duodenum, catarrh of the biliary ducts, and the jaundice dependent 
thereon, are, after the acuter symptoms have subsided, greatly bene- 
fited by the smaller doses of iodide of sodium or ammonium. This 
is one of the best remedies for the first stage of cirrhosis. The efficacy 
of the iodide is increased by combination with arsenic : fy Ammonii 



246 AGENTS INCREASING WASTE. 

iodid., 3 j; Hq. potassii arsenitis, 3 ss; tinct. colombae, % ss; aquas, § ja& 
M. Sig. : A teaspoonful three times a day, before meals. 

The preparations of iodine and the iodides are, generally speaking, 
contraindicated in all inflammatory states of the intestinal canal ; but 
in passive hcemorrhage, and diarrhoea from atony of the mucous mem- 
brane, the tincture or compound solution of iodine in small doses — one 
or two drops — frequently repeated, renders important service (Schmidt). 

Large doses (grs. xv — 3 ss) of the iodide of potassium, three or 
four times a day, often afford remarkable relief in aneurism, and some- 
times effect a cure. The author has seen several instances in which 
great benefit was derived from it, and one case certainly in which a 
cure apparently resulted. He is, therefore, able to confirm the observa- 
tions of Chuckerbutty, Roberts, Balfour, and others. 

In arteriosclerosis and in sclerosis of the heart, kidneys, and other 
organs, our French colleagues maintain that the iodides possess distinct 
curative power, if given in sufficient quantity, for several years. About 
one drachm daily is the minimum amount that will accomplish the ob- 
ject. As, however, the potash base is more injurious in action than 
the soda base, the iodide of sodium should be preferred for this pur- 
pose. Prof. See, Heuchard, and others of the French school, are con- 
vinced that the condition of sclerosis, which, as it affects the arterial 
system, plays an important part in pathogeny, can be arrested, the mor- 
bid deposits removed, and the integrity of the vessels restored. Pro- 
longed use of the iodide of sodium, although not without its disadvan- 
tages, can be safely carried on if occasional intermissions are allowed. 

In summer catarrh or hay-asthma, the best results are obtained by 
the use of larger doses, and the efficacy of the iodides is increased by 
combination with arsenic : fy Potassii iodidi, § j ; liq. potassii arse- 
nitis, 3 j ; aquae, § iv. M. Sig.: A teaspoonful every four or six hours. 
With the internal use of the iodides may be combined the local use, to 
nares and fauces, of the following solution : 1$, Tinct. iodinii, 3 j ; 
acid, carbol., gtts. x ; aquae destil., % iv. M. Sig.: Apply with a post- 
nasal syringe. Ethyl iodide is especially valuable inhaled frequently. 

The iodide of potassium is one of the most effective remedies which 
we possess for spasmodic asthma. But it is not adapted to all cases 
arising under various conditions — a fact which explains the difference 
of opinion on the subject between Williams, Salter, and others. It is 
most beneficial when the asthmatic seizures are reflex. Salter, how- 
ever, holds that we possess no exact indications for its use, and that 
cases the most diverse are sometimes benefited in a remarkable manner. 

Chronic bronchitis, with profuse secretions (bronchorrhoea), is fre- 
quently improved by the iodides, more especially the iodide of am- 
monium. The efficacy of this remedy is increased by the conjoined 
administration of arsenic. In capillary bronchitis, the author has 
witnessed most astonishing relief by the rapid administration of iodide 



IODINE AND IODIDES. 247 

of ammonium in small doses. It may be combined with the carbonate, 
or with the stimulant expectorants. To remove the deposited inflam- 
matory exudations of catarrhal and fibrinous pneumonia, no remedy is 
more efficient than the iodide of ammonium. To lessen the effect of 
this remedy on the tissue-changes, arsenic should be combined with it, 
and every means used to support the body nutrition. The iodide of 
potassium is one of the remedies resorted to in chronic pleurisy, to 
promote absorption of effusions. In these cases the iodides are admin- 
istered steadily for a considerable period, and pilocarpine given, as 
may be necessary, to increase the sorbifacient action. 

Affections of the broncho-pulmonary mucous membrane, alluded 
to above, in which there is profuse exudation, all inflammatory symp- 
toms having subsided, are advantageously treated by iodine inhala- 
tions. The method which the author has found most convenient is 
the following : A small, wide-mouthed bottle, containing a moistened 
sponge, is placed in a vessel of hot water. The tincture of iodine 
(gtts. v — gtts. x) is dropped upon the sponge, and, as the vapor of 
iodine rises, is inhaled with the vapor of water. This inhalation is 
serviceable in acute catarrh, hay-asthma, and chronic bronchitis. The 
carbolate of iodine (tinct. iodi, 3 ij ; acid, carbol., 3 j ) may be used 
instead of the simple tincture of iodine. Ten to twenty drops for 
inhalation. 

But few affections of the brain, non-specific in origin, are benefited 
by the iodides. According to Niemeyer, the iodide of potassium given 
to iodism has in few instances cured basilar meningitis. The author, 
who has used it faithfully in various cases, has not been so successful. 
Trousseau et Pidoux express their disbelief in the reported cures of 
tubercular meningitis by this agent. Seguin maintains, on the other 
hand, that remarkably good results sometimes follow the use of large 
doses of the iodides in other than specific diseases — in the various sub- 
acute and chronic inflammatory affections of the meninges and brain. 

No remedy is more efficient in the treatment of certain glandular 
enlargements of the thyroid, spleen, and lymphatic glands. Goitre is 
curable by the internal and external application of iodine, when it con- 
sists of simple hypertrophy of the gland-elements. Cystic and calca- 
reous degeneration of the thyroid are unaffected by the use of iodine 
preparations never so vigorously used. One of the best remedies for 
true goitre, as will be seen hereafter, is the unguentum hydrarg. iodidi 
rubri. Enlarged spleen, when it consists merely of an hypertrophy of 
the organ (chronic splenitis), is cured by the internal use of the iodides 
conjoined with the local use of iodine-paint, or ointment of the red 
iodide of mercury. The enlargements of the spleen and liver, with 
functional derangement of these organs, which are caused by malarial 
disease, are most effectually removed by moderate doses, frequently 
repeated, of the iodide of ammonium. The author's experience jus- 



248 AGENTS INCREASING WASTE. 

tifies him in strongly urging the combined use of iodide of ammonium 
and arsenic in chronic malarial poisoning. 

The prolonged administration of the iodides has the power to re- 
tard the growth and to remove the changes which ensue in chronic 
BrigMs disease (fibroid degeneration), and the arterio-sclerosis ac- 
companying it. 

The utility of the iodides is most conspicuous in certain constitu- 
tional states. The expectations which were at first entertained of the 
cure of scrofula by iodine and its preparations have not been realized. 
The iodides are unquestionably useful in the scrofulous (so called) 
enlargements of the lymphatic glands, but cod-liver oil and suitable 
hygienic means are more influential in improving the strumous di- 
athesis. The preparations of iodine are effective only when simple 
hypertrophy of the lymphatic glands has taken place ; if they have 
undergone caseation, or have proceeded to suppuration, no medicine 
has any influence over them. 

The most important therapeutical applications of the preparations 
of iodine are in the treatment of constitutional syphilis. For the pri- 
mary and secondary stage, mercury is generally admitted to be best ; 
but for tertiary symptoms no remedy at all approaches the iodide of 
potassium. In the secondary affections of the skin, mercury, especially 
if it have not been given for the primary troubles, is to be preferred 
in the papular, tubercular, squamous, and pustular syphilides ; iodide 
of potassium in the ulcerating, especially if the patient is cachectic. 
It may be stated in general that the preparations of iodine are indi- 
cated when the patient is under the mercurial cachexia. On the other 
hand, it is well known that sometimes, even when the tertiary symp- 
toms have not been relieved by a thorough course of iodides, mercury 
will quickly remove them. But this fact does not invalidate the rule 
that the iodides are specially serviceable for the tertiary period. 

No therapeutical fact is more conspicuous than the cure of syphi- 
loma of the nervous system by iodides. Mental disorders, epileptiform 
seizures, paralytic states, etc., dependent on gummata, nodes, etc., are 
usually removed in a manner little short of magical. Neuralgia of the 
fifth {tic- douloureux), the pain being nocturnal chiefly, or nocturnal 
pain in the head, is similarly promptly cured. In syphilitic affections 
of the brain, more imperatively than in the same affections of other 
organs, are large doses of the iodide of potassium required. The limi- 
tation of the dose depends entirely on the physiological susceptibility 
of the patient, and the influence exerted over the progress of the case. 
Hence the dose may vary from ten grains to a drachm every four hours, 
or three or four times a day. The symptoms of iodism — the use of the 
agent to saturation — should be induced ; for this effect is the only 
measure of the therapeutical power of the remedy. The more promptly 
iodism can be induced, the better, for the soft nervous tissue may 



IODINE AND IODIDES. 249 

be quickly and irreparably damaged by syphilitic deposits and new- 
growths. Syphilitic paraplegia is equally amenable to the same 
means ; but, as above remarked, much depends on the promptness 
with which the iodide is used. 

Recent experience has conclusively shown the curative power of 
iodine in malarial fevers. Thus three hundred consecutive cases were, 
with few exceptions, promptly arrested (Anderson). In some cases no 
paroxysm occurred after the medicine was administered ; sometimes 
the attacks persisted for two or three days, but then the relief was 
complete. The official compound tincture of iodine may be prescribed 
— for adults, ten to fifteen minims, three times a day, well diluted, and 
before meals. Carbolic acid, itself having considerable anti-periodic 
power, may be combined with the tincture of iodine. £jt Tinct. iodi, 
| ij ; acid, carbolic, 3 ij. M. Sig. : Ten to fifteen minims three or 
four times a day. The tincture of iodine is stronger than the com- 
pound tincture. If quinine be necessary to break up the paroxysms, 
iodine is highly useful in the interim, as has been indicated. Some 
recent experiences by Dr. Atkinson, of Baltimore, throw doubts on 
the previous statements. He found that iodine failed in two thirds of 
the cases of intermittent fever. 

The use of the compound solution of iodine during the course of 
the first and second week of typhoid fever is known in Germany as 
the " specific treatment." A very considerable reduction in mortality 
appears to have followed this method. The solution of iodine or the 
tincture is administered regularly three times a day, well diluted with 
water. When it does good, the temperature falls, the nausea lessens, 
and the diarrhoea is restrained within safe limits. 

Chronic rheumatism, when there are present thickening of the 
fibrous tissues, and inflammatory depositions about joints, tendons, peri- 
osteum, and nerve-trunks, is often very signally benefited by the iodides. 
The cases in which these remedies prove so serviceable are most prob- 
ably due to syphilitic, mercurial, saturnine, or other constitutional 
causes. There are, in our modern life, many ways in which these 
mineral poisons enter the organism, and it is probable that they are 
often undiscovered and even unsuspected causes of rheumatic symp- 
toms. Lumbago, sciatica, and paraplegia, apparently of rheumatic 
origin, and curable by the iodides, may not unfrequently be caused by 
syphilis, mercury, copper, tin, or lead. 

The various accidents caused by the metals above named, especially 
the mercurial and saturnine, are removed by the use of the iodides, 
notably by the iodide of potassium. With regard to the dose neces- 
sary, what is true of syphilis is equally true of the mineral poisons : in 
order to remove them, the organism must be saturated by the remedy. 
From fifteen grains to a drachm, three or four times a day, should be 
given j but the measure of the quantity required is the effect pro- 



250 AGENTS INCREASING WASTE. 

duced. The iodides penetrate into every tissue, convert the deposited 
metal into soluble combinations, and cause them to be discharged by 
the various organs of excretion, chiefly by the kidneys. It has been 
repeatedly asserted that salivation may be induced, and existing sali- 
vation increased, by the use of the iodides for the removal of mercu- 
rial salts from the organism ; but the author has not witnessed any 
facts which support this statement. 

In shin-diseases of syphilitic origin there can be no question as to 
the utility of the iodides. But these remedies are more especially cura- 
tive in the tertiary affections, especially in destructive syphilitic ulcera- 
tions. Hebra insists, and with justice, that the preparations of iodine 
are only useful in lupus, whether syphilitic or scrofulous, and do not 
permanently improve other cutaneous diseases. Greve asserts that 
large doses of the iodides (3 j- 3 j ter die) rapidly cure psoriasis / and 
in this opinion specific origin is not said to be necessary to the cura- 
tive result. Boeck confirms Greve's statements. 

Local Uses of the Preparations of Iodine. — The tincture of 
iodine is in universal use as a counter-irritant. It is applied by means 
of a camel's-hair brush to goitre, to enlarged glands, and to superficial 
inflammatory swellings before the formation of pus. Painted over the 
neck, it is a useful counter-irritant in acute affections of the pharynx 
and larynx, and to the chest to relieve the chest-pains which occur in 
phthisis. It is the most serviceable counter-irritant to promote absorp- 
tion of inflammatory products in catarrhal and fibrinous pneumonia 
after the acuter symptoms have subsided. The same application ap- 
pears to possess the power to promote the absorption of pleuritic effu- 
sion. It is a good plan in these affections to paint, on successive days, 
the tincture over the front, the lateral, and the posterior wall of the 
chest, so that one surface has time to recover from the irritation before 
it is again attacked. As the susceptibility to the action of the iodine 
varies in different subjects, it is always prudent to make a slight appli- 
cation in the beginning. If extreme burning follow the applications, 
the iodine may be dissolved off by a solution of iodide of potassium, 
by alcohol, or ether. 

The tincture and the ointments of iodine are also used to remove 
the induration of the breasts which results from attacks of inflamma- 
tion. It must be remembered that the integument in this situation is 
extremely sensitive to irritating applications. Splenic and hepatic dis- 
orders of a chronic hind are frequently treated locally by the applica- 
tion of tincture and ointment of iodine. Enlarged spleen of malarial 
origin is more speedily cured by the application of the official red 
iodide-of -mercury ointment, and, as regards hepatic disorders, the only 
affection which has seemed to the author to be benefited by iodine ap- 
plications is the engorgement due to malarial attacks. 

After the acute symptoms have subsided, tincture of iodine will re- 



IODINE AND IODIDES. 251 

move the swelling of orchitis. The scrotum, like the female breast, is 
very sensitive to the irritation of iodine tincture and ointments. Bubo, 
like the enlarged lymphatic glands in other situations, may be treated 
by the application of iodine-tincture, but it is not very effective. 

Although Hebra does not approve of the internal use of iodine in 
cutaneous diseases, he advises the local application. He employs the 
tincture or glycerine solution in chloasma, lentigo, and lupus. The 
tincture of iodine is used to prevent the pitting of small-pox. Accord- 
ing to Piringer, it should be applied as follows : If on the first day of 
the eruption, the whole face, including the eyelids, is brushed over with 
the tincture of iodine ten times, there being an interval of a half -hour 
between each application ; if on the second day, twelve applications ; 
if on the third day, twelve to sixteen applications. The tincture of 
iodine is sometimes painted over the affected surface in erysipelas, and 
over the surrounding healthy integument, to prevent the spread of the 
disease, but, according to the author's experience, it is bad practice. 

Iodoform may be substituted for iodine in the form of the official 
ointment. This may be used locally, rubbed in, as the iodine-oint- 
ments are, for the relief of local inflammatory swellings, enlarged lym- 
phatic glands, goitre, etc. The strong, diffusive, and peculiar odor of 
iodoform is an objection to its use in this way. Iodoform powdered 
and dusted over the diseased surface is an excellent application to 
sloughing and ill-continued wounds, irritable ulcers, rodent idcer, chan- 
croid, sloughing phagedena, and serpiginous syphilitic idcers. It allays 
pain, changes the morbid action, and is antiseptic. Syphilitic idcers 
of the tonsils, pharynx, and tongue, are most effectually treated by local 
and direct application of powdered iodoform. In these cases the pow- 
der may be blown on to the surface of the ulcer by an insufflator or 
insufflation-tube. Fissures of the anus, hemorrhoids and idcers of 
the rectum, are improved in condition, and the pain which attends them 
relieved by application of the ointment of iodoform and by iodoform 
suppositories. The latter are also of undoubted service in chronic 
metritis and hypertrophy of the prostate when introduced into the 
rectum ; the iodoform diffuses into the neighboring organs, and acts 
directly upon them. The pain of cancer may be somewhat relieved, 
and the fetid odor which attends the discharges may be removed, by 
the application of iodoform to the diseased surface. This treatment 
may be applied to cancer in any situation, but is especially applicable 
to cancer of the uterus and rectum. 

The parenchymatous injection of tincture of iodine is a remedial 
means of great importance. The method of employing it is exceeding- 
ly simple. An ordinary hypodermatic syringe (glass or hard rubber) 
is charged with five to fifteen minims or more of the tincture, and the 
needle is thrust deeply into the affected tissue, and the iodine is slowly 
discharged. For injection into parts very deeply situated, long needles, 



252 AGENTS INCREASING WASTE. 

such as are made for aspiration, can be used. This method of treat- 
ment is very effective in hypertrophied tonsils, goitre, glandular tumors, 
and the compound cystic and glandular growths so frequently found 
in the neck. The author has witnessed the cure of many cases of this 
kind by the parenchymatous injection of tincture of iodine. Some pre- 
cautions must be attended to in practicing these injections. When the 
point of the needle is inserted as deeply as desired, it should be moved 
about to disengage it from any vessels into which it may have pene- 
trated. Recent observations (1887) by Terrillon and Sebileau have 
fully confirmed the opinion expressed above as to the value of iodine 
injections in the simple and fibroid goitre, and they express a decided 
preference for iodine tincture over the ethereal solution of iodoform, 
recently recommended. 

When hydrothorax returns after evacuation of the cavity by the 
trocar, the compound solution of iodine or the tincture may be injected 
into the pleural sac. In empyema, the undiluted tincture of iodine may 
be thrown in without risk, and with great benefit. Ordinarily, a solu- 
tion of the following strength may be used to wash out the cavity in 
cases of empyema : 3 ^iq. iodi comp., § j ; aquae, § xv. M. 

Hydatids oftJie liver may easily be destroyed by injecting into them 
a few drops of tincture of iodine. It has, however, been shown that in 
some instances sinrple capillary puncture and withdrawal of the fluid 
suffice to arrest the growth and to abort these parasites. Injection of 
tincture of iodine is one of the means resorted to to cure hydrocele. 

It is said that hypertrophied prostate may be diminished and fur- 
ther enlargement prevented by parenchymatous injection of iodine. 
In the performance of this operation a Sims or bivalve rectal speculum 
is inserted, and the needle of the syringe is passed through the walls 
of the rectum into the gland. Careful palpation previous to the inser- 
tion of the needle will enable the operator to avoid important vessels. 

JJnilocxdar ovarian cysts may sometimes be cured by injecting 
into them, after the withdrawal of the fluid, ten to sixteen ounces of 
tincture of iodine. No other form of ovarian cyst will, however, be 
affected favorably by this expedient. 

Large abscesses may be made to close much more speedily than 
they would otherwise, and septic infection be prevented, by the injec- 
tion of iodine-tincture after the evacuation of the matter. 

Numerous cases of spina bifida have been cured by the injection 
into the sac of tincture of iodine ( 3 ss ), or a solution of iodine (gr. ss) 
and iodide of potassium (gr. v) in water ( 3 j ). 

lodo- Tannin. — This is an excellent application for local diseases. 
Tannin may be dissolved to saturation in tincture of iodine, or an aque- 
ous solution may be prepared as follows : $ Iodi, 3 j ; acid tannici, 
5 j ; aquae, Oj. After filtration, to be evaporated to 5 iv. 

The author has found a saturated solution of tannin in tincture of 



IODINE AND IODIDES. 253 

iodine is a most efficient application in all those cases of uterine disease 
in which the tincture of iodine and iodized cotton and iodized glycerin 
are now so much used. It is serviceable in chronic cervicitis, chronic 
endo-metritis, sub-involution and hypertrophy of the uterus. The au- 
thor has also found that the following combination is a capital appli- 
cation in leucorrhoea and the above-named uterine affections : ^ Iodo- 
formi, 3 j ; acid, tannici, § j. M. A sufficient quantity to be packed 
in the dry state around the cervix. 

The iodide of starch is used by Mr. Marshall as a dressing for syphi- 
litic ulcers, and he speaks highly of its efficacy. 

A decolorized tincture of iodine for external use may be prepared 
as follows : iodine, hyposulphite of sodium, distilled water, of each ten 
parts. Dissolve with a moderate heat, and add sixteen parts of spirits 
ammonia, and, after a few minutes' agitation, add seventy-five parts 
of alcohol. The solution must stand in a cool place for three days, 
and then be filtered (Waldenburg und Simon). Decolorized iodine is 
of doubtful utility. 

An extemporaneous iodo-tannin may be prepared according to the 
formula of Sigmund : fy Tinct. iodi, tinct. gallse, aa § ss. M. The 
strength of this may be increased by the addition of iodine 2)ij. 

Ether Hydriodicus— Iodide of ethyl. Ethyl iodide. 

This is a colorless, non-inflammable liquid. The odor is peculiar, 
very powerful and diffusible, and the taste pungent. It is not soluble 
in water, but dissolves to some extent in alcohol. Its specific gravity 
is 1*92, and its boiling-point 160° Fahr. Exposed to light and air it 
assumes a dirty, brownish-yellow color, from the setting free of iodine ; 
hence it should be kept in closely-stoppered bottles in the dark. The 
dose is five to twenty drops inhaled from a handkerchief, or from the 
vial containing it, three or more times a day. 

Physiological Actions. — Although ethyl-iodide might be classi- 
fied with the other anaesthetic agents, its physiological and therapeuti- 
cal effects ally it more nearly to the iodides. As an anaesthetic, the 
action is slow and imperfect. Dr. Lawrence, of Boston, testing the 
action in his own person, found that a half -hour of inhalation failed to 
produce even drowsiness. It is said, however, that it induces the anaes- 
thetic state in animals, but further information is needed on this point. 

Hydriodic ether offers a ready and effective means for introduc- 
ing iodine in the system. M. Huette first employed it for this pur- 
pose, and his observations were afterward confirmed by Mr. Turnbull, 
of Liverpool. Then Dr. Fisher, of New York, also used it with the 
same object. Probably, the most satisfactory observations which 
have been made are those of Dr. Lawrence, of Boston, who not only 
studied the physiological action of this ether, but indicated the mala- 
dies in which it is useful. 



254 AGENTS INCREASING WASTE. 

Tiieeapy. — Ethyl iodide is administered by the broncho-pulmonary 
mucous membrane. Five to twenty drops are put on a handkerchief 
and inhaled as may be necessary — every two, three, or four hours, or 
more or less frequently ; or, contained in a small vial, the heat of the 
hand suffices to disengage the vapor, which can then be inhaled 
directly. As a means of introducing iodine into the blood, it offers 
many advantages. When, therefore, it is necessary to induce iodism 
speedily, as in syphiloma of the brain or spinal cord, it is an appro- 
priate remedy. In the spasmodic affections — the neuroses of the re- 
spiratory organs — as asthma, emphysema, whooping-cough, etc., when 
accompanied by catarrh of the mucous membrane especially, excel- 
lent results are obtained from the inhalations. Dr. Lawrence has 
found it of exceptional utility in asthma. Good effects may be had 
from it in capillary bronchitis, in chronic bronchitis, in fibroid 
phthisis, in caseous phthisis, and in local catarrhs of the air-passages. 

Iodoformum. — Iodoform. — Iodide of f ormyl. Small, lemon-yellow, 
lustrous crystals of the hexagonal system, having a saffron-like and 
almost insuppressible odor, and an unpleasant, slightly sweetish iodine- 
like taste. Not perceptibly soluble in water, to which it imparts a 
slight odor and taste ; soluble in 80 parts of alcohol at 15° C. (59° 
Fahr.) and in 12 parts of boiling alcohol, in 5*2 parts of ether, and in 
chloroform, benzol, benzin, disulphide of carbon, fixed or volatile oils. 
It sublimes slightly at ordinary temperatures. (U. S. P.) 

Unguentum Iodoformi. — Iodoform ointment. Iodoform, 10 parts, 
benzoinated lard, 90 parts. 

Actions and Uses. Notwithstanding iodoform contains 97 per 
cent of iodine, it possesses properties in some respects different from 
that agent. Discovered by Serullas in 1822, it was not prescribed 
until 1836, when Bouchardat used it because of the large quantity of 
iodine contained in it. In 1853 D'Olleggio brought it forward as a 
disinfectant and deodorizer ; and in 1856 MM. Moretin et Humbert 
showed it might be substituted for the iodides, because easily absorbed 
and free from any irritant properties. They also demonstrated that 
iodoform has anodyne effects, that it induces analgesia of the rectum 
when applied to it, and that it can be used in the same classes of dis- 
ease as iodine, and in some neuralgias and painful affections of the 
bladder and prostate. In 1866 Dr. Eastlake, in the course of a paper 
on uterine therapeutics, referred to iodoform as a valuable sedative in 
uterine cases. Dr. Greenhalgh soon after confirmed these observa- 
tions. The following year, Yoelker added some new facts of the 
same kind. In 1868 Fereol, in a paper read before the Therapeutical 
Society, gave full details regarding the effects of iodoform on wounds, 
fully anticipating many of the observations since made on its antiseptic 
and healing properties. 



IODINE AND IODIDES. 255 

Little attention had been given to iodoform in Germany, before 
the investigation made by Binz. Moleschott followed these researches 
by some important chemical observations, and afterward Mosetig and 
Mikulicz, of Vienna, and Gussenbauer, of Prague, set forth the remark- 
able virtues of this substance as an antiseptic dressing. Since these 
communications appeared, the use of iodoform has received enormous 
extension, and its popularity has attained to such extravagant propor- 
tions, that the wide-spread enthusiasm may be entitled iodoform-mania. 
There can be no question, however, as to its utility. There are, never- 
theless, limitations to its employment, imposed by the nature of the 
substance. It seems desirable, hence, to set forth in a special article its 
actions and uses, according to the modern conceptions of its powers. 

As iodoform contains 97 per cent of iodine, it may be supposed to 
have analogous properties, but, as the iodine is combined with the radi- 
cal formyl, another influence enters into the action. Applied in the 
form of crystals or as a powder, the immediate effect is that of the 
compound — iodide of formyl — and not that of iodine merely, or of 
formyl merely ; but the latter distinctly modifies the former ; hence 
there is more or less of an anodyne effect. Binz holds that when iodo- 
form is applied to a wound it is dissolved in the fatty bodies of the 
organism, and that iodine is disengaged to form iodides and iodates. 
Hogyes, on the contrary, maintains that the iodine when set free unites 
with albumen, and afterward forms salts. Moleschott explains the 
more energetic action of iodoform by the assumption that it is readily 
decomposed in the blood, and that the free iodine in its nascent form 
has more energetic affinities (Rohmer). In what manner soever its 
mode of action may be explained, the main point, in regard to which 
all are agreed, is, that the action of iodoform is chiefly due to the io- 
dine. The effects of iodine have already been set forth, and hence no 
further statements are necessary ; but the antiseptic action of iodoform, 
to which its present applications are chiefly due, requires further ex- 
position. Mikulicz has especially studied the effect of iodoform on 
decomposing animal substances, and he finds that it prevents change 
and arrests decomposition when begun. For the purpose of determin- 
ing its power to prevent putrefaction, he employed Pasteur's liquid, 
composed of extracts of foods, of malt, of peptones, of alkaline urine, 
and of bouillon, and blood, and covered this mixed solution with pow- 
der and crystals of iodoform. The experiment was varied by adding 
iodoform in different quantity to solutions having the same composi- 
tion, and a " control experiment " was employed, to verify the results. 
It was shown that, in those solutions treated with sufficient iodoform, 
there was absolutely no development of minute organisms, while in 
the " control " fluid the germs were abundant and the putrefactive 
process active. In contact with wounds it has a very prompt and 
thorough antiseptic action. It promotes union and cicatrization, and 



256 AGENTS INCREASING WASTE. 

at no time are there any heat, redness, swelling, or pain produced by 
it at the point of application. There is very little secretion from the 
wound treated by the application of iodoform, and the little observed 
has rather a serous than a purulent character. When a considerable 
loss of substance is to be closed by granulations, iodoform does not 
act so well, it is said, and hence, when the granulations have filled the 
wound up to the level of the skin, it is better to substitute solutions of 
nitrate of silver, of acetate of lead, etc. 

Notwithstanding iodoform acts in many respects like iodine, there 
are differences. When the iodides or iodine tincture are given in suf- 
ficient doses, among the phenomena of iodism caused are coryza, 
pharyngeal and laryngeal catarrh, etc., and there ensues very consid- 
erable wasting of the tissues in general. On the other hand, when 
iodoform is given, wasting does not occur, but the body-weight in- 
creases, the complexion grows better, and the general condition im- 
proves in every way (Rohmer). It can not be affirmed, the author 
believes, that these beneficial results are constant for all doses of the 
remedy administered by the stomach, or for all quantity when applied 
topically. In fact, the first enthusiasm awakened by the discovery of 
the antiseptic pow T ers of iodoform has been chilled by the untoward 
results of too lavish application. Not only dusted over the wounded 
surface, but applied in thick layers, it was soon found that, notwith- 
standing the slow absorption of iodoform, sufficient entered the blood 
to produce alarming, serious, even fatal symptoms. 

Poisoning by Iodoform. — It is very important to have a clear con- 
ception of the mischief which may be thus caused. As iodoform, or 
some corresponding chemical, will probably continue to have an im- 
portant place in the antiseptic method of surgical dressings, and as it is 
also much employed in medical practice, the practitioner should learn 
to recognize the untoward symptoms. " Eseter, of Trieste," says Lou- 
guet, "had a case of death from the iodoform-mania." But many 
deaths have since followed from the too lavish use of this agent. An 
idiosyncrasy is observed in some subjects — a special susceptibility to 
the action of the iodides in general, and to iodoform in especial. It 
sometimes happens that this idiosyncrasy develops suddenly and with- 
out warning, and the toxic symptoms occur at once, death quickly ensu- 
ing, although the remedy is suspended (Schede). When the action of 
iodoform is unfavorable, the symptoms observed have been as follows : 
1. Rise of temperature to 104° Fahr., or even higher. 2. In addition to 
fever, there will be headache, loss of appetite, a rapid pulse, low tension 
of the vessels, etc., but the symptoms m both classes will quickly dis- 
appear if the remedy is discontinued. 3. In this form of iodoform- 
poisoning, the pulse is quick, reaching even 180, and is feeble ; there is 
much depression of the forces in general, and the condition of the mind 
is anxious, restless, and melancholic. These symptoms may be caused 



IODINE AND IODIDES. 257 

in some subjects by the first application of iodoform, or may come on 
after an apparent tolerance has been established. 4. In this group of 
toxic cases, the same symptoms occur as in the third, viz., high fever, 
melancholia, etc., but the termination is quickly fatal, although the ap- 
plication of the remedy is stopped. 5. In this group, the symptoms of 
a profound depression come on, and death speedily occurs in a condi- 
tion of collapse. In many examples of this kind, it may well be a 
question whether this accident is not due to the injury of operative 
procedures. 6. In the more formidable results of iodoform applica- 
tions, very decided cerebral symptoms have been observed. These 
have been described by Schede and Kiister more especially, and are 
mentioned by them in connection with the several classes of iodoform- 
poisoning above referred to. There is, however, a condition of the 
cerebrum caused by iodoform-poisoning characterized by disordered 
stomach, high fever, dilated pupils, melancholic depression, stupidity 
of mind, involuntary evacuations, hallucinations, etc. 

Notwithstanding the above-described forms of poisoning have a 
real existence, it is held by Mundy, Czerny, Ktister, and others, that 
now and then, probably frequently, a septicemic state, and undiscov- 
ered complications, are responsible for the symptoms attributed to 
iodoform. Making due allowance for such an error, there are still 
examples of the toxic effects of iodoform ; hence the need of proper 
caution in using it topically. 

Treatment of Iodoform Intoxication. — The first step consists in 
the withdrawal of the application, and every adherent particle should 
be at once removed. The powers of life should be supported by a 
judicious use of stimulants, and especially by small doses of the tinc- 
ture of opium, frequently repeated. Elimination should be promoted 
by diluents freely administered. 

The most important point as regards prophylaxis is to avoid too 
lavish use of the agent. Schede says that large flesh-wounds should 
not be filled with iodoform, for then it can be removed only with the 
scab. Granulating surfaces absorb less, but here the danger of in- 
toxication also exists. Mundy advises that a small quantity only of 
the powder be dusted over the wound, that the dressings be allowed 
to remain, and that close sutures and tight bandages be avoided. It 
appears that caution is needed in the application to the amputated 
breast, and in all operations involving the peritonaeum. As to quantity 
used, we are guided by the results following lavish use. Three hun- 
dred grammes in one case (Beger), 100 to 200 grammes (Henri) in 
another, have induced poisoning. Death followed the use of 35 to 40 
grammes (542 to 620 grains) in a case of operation involving the peri- 
tonaeum (Ktister). 

Von Mosetig-Moorhof has employed iodoform in several thousands 
of surgical cases without a single instance of poisoning, and he attrib- 
18 



258 AGENTS INCREASING WASTE. 

utes this favorable result to the fact that he has not used large quanti- 
ties of the remedy, that the wound was not subjected to pressure, that 
the dressings were frequently changed, and that carbolic acid was not 
used at the same time. 

Mode of applying Iodoform. — The simplest mode consists in merely 
dusting tbe powder over the surface, wound, or sore, to be acted on. A 
common tin pepper-box or an insufflator may be utilized for this pur- 
pose. Gauze or absorbent cotton may be saturated with an ethereal 
saturated solution of iodoform and applied according to the methods 
of Lister. Iodoform and tannin may be applied in any desired pro- 
portion after they have been thoroughly triturated together. Iodoform 
may also be suspended in a mixture with gum — with glycerin and gum- 
tragacanth. As the odor of this substance is so diffusive and persist- 
ent, various means have been resorted to for its removal or modifica- 
tion. The essential oils, the balsams of Peru and tolu, essences of all 
kinds, menthol, eucalyptol, and thymol, have been employed with vary- 
ing success ; of these, thymol appears to be the best, for, while it modi- 
fies the odor, it less impairs the antiseptic qualities. The mixture of 
iodoform and thymol may be in any desired proportion. Lindemann 
advises the following mixture : Iodoform, 1 part ; balsam of Peru, 
3 parts ; and vaseline, 8 parts : or iodoform, 1 part ; balsam of Peru, 
3 parts ; alcohol, glycerin, or collodion, 12 parts. Recently, pulverized 
roasted coffee has been shown to be very effective, and this material 
does not impair the peculiar qualities of iodoform, as many of the 
disguises now used do. 

Therapy. — In general it may be stated that iodoform is now used 
in all the icounds, injuries, diseases, requiring the action of an anti- 
septic. Chancres, ulcers, sloughing and p>hagedenic xdcers, surgical 
operations, etc., are especially benefited by its application. It is, 
above all topical remedies, the most appropriate for gunshot loounds 
and injuries (Mundy). As an antiseptic remedy, it has hardly kept 
the position originally attained, for it has proved to be less destruc- 
tive of pathogenic organisms than was supposed during the period of 
"iodoform mania." Notwithstanding this change in opinion and prac- 
tice as to its utility in surgical maladies, there has been a steady 
growth in the appreciation of iodoform in certain diseases of internal 
organs — in phthisis, hepatic disorders, malarial troubles, etc. 

For internal use the dose of iodoform will range between one half 
a grain to five grains, but the usual dose for an adult, free from any 
idiosyncrasy as to its action, is two grains, three to six times a day. 
The most suitable form for administration is the pill, or capsule ; but 
for some affections, solution in cod-liver oil makes an advantageous 
preparation. 

In chronic gastric catarrh, gastro-duodenal catarrh, and when the 
catarrhal process invades the hepatic and pancreatic ducts, iodoform 



IODINE AND IODIDES. 259 

renders an important service. It checks fermentation, and modifies 
the catarrhal troubles. The most conspicuous and valuable effects 
are those produced in catarrhal jaundice — for the remedy not only 
lessens or removes the morbid action going on in the liver-ducts, but 
it promotes elimination of the bile acids and pigment contained in the 
blood. The author has reason to believe that cirrhosis of the liver, if 
the disease is not too far advanced, especially the hypertrophic form, 
may be arrested by the diligent and persistent use of iodoform in 
moderate doses. Combination with the salts of manganese — the sul- 
phate chiefly — increases the action, and has been ascertained to be 
peculiarly effective in gouty subjects. 

In chronic dysentery, good results have been obtained by iodoform 
injections (Culbertson). The systemic effects of iodoform are sedative 
and resolvent (Kirsch), and it has been applied with some success in 
phthisis and in strumous affections, but has not proved useful in 
syphilitic adenitis, although a priori it would appear to be clearly 
indicated. There is much evidence that it is beneficial in the more 
chronic cases of phthisis, and in those originating in chronic bronchitis 
and in exudative pleuritis, but examples showing its remarkable power 
in phthisis florida have also been recently published. In a highly in- 
teresting and valuable paper read by Dr. Shingleton Smith before the 
International Medical Congress, he presents the results obtained from 
its internal administration by numerous observers in various countries. 
All forms of phthisis are included, and the results of the practice as 
reported by such authorities as Prof. Semmola, of Naples ; Dr. Cols- 
feld, of Bremen ; Drs. Rummo and Renzi ; Dr. Dreschfeld, of Man- 
chester, and Dr. Shingleton Smith, are included in the summary. The 
therapeutical effects were gain in weight, increase of appetite, lessen- 
ing of cough and expectoration, lowering of the temperature, and de- 
cided diminution, often entire suppression, of sweating. Although, as 
has been stated, iodoform is not one of the more active germicides, it 
is very destructive of the bacillus tuberculosis, which is remarkably in- 
hibited, and its pullulation prevented. With the internal treatment 
the topical may be combined, the iodoform in the finest powder, ap- 
plied by means of an insufflator, or the ethereal solution, inhaled. Also, 
simultaneously, ethyl iodide can be inhaled, with or without iodoform 
dissolved in it. Drs. Renzi and Rummo have ascertained that the 
systemic effects of iodoform are more promptly and powerfully pro- 
duced when this agent is taken by inhalation than when it is adminis- 
tered by the stomach. 

In cases characterized by insufficient oxidation, as the so-called 
lithcemia, diabetes, obesity, etc., iodoform has proved highly effective 
in some instances. The amount of testimony in regard to its benefi- 
cial action in diabetes is quite considerable. The physiological basis 
for its administration in these maladies consists in its power to increase 



260 AGENTS INCREASING WASTE. 

the conversion of uric acid into urea, and to promote combustion of 
the nitrogenous material submitted to its action (Testa, Moleschott, 
Ransome, and others). In cases of obesity, it is highly effective, as 
compared to the influence of other remedies ; but it should not be for- 
gotten that it causes rapid wasting and anaemia, probably because of 
the injury done to the red blood-corpuscles (Bozzolo), and hence it 
must be administered with caution, and in combination with other 
remedies that will lessen its injurious action on nutrition. Moleschott 
reports that, in five cases of diabetes, iodoform, in doses of one and a 
half to three grains, rapidly reduced the quantity of sugar and caused 
its disappearance in four or five days, although no change in diet had 
been made. If these extraordinary results are confirmed by the ex- 
perience of others, it will be impossible to overestimate the value of 
iodoform as a remedy. 

The susceptibility to the toxic action of iodoform varies so great- 
ly that no arbitrary rule of dosage can be properly made. One 
grain may, if given frequently, cause iodism in some subjects ; on the 
other hand, three-grain doses may be continued for a long time with- 
out any unpleasant effects. Gastric disorder, drowsiness, maniacal 
excitement, weakness, impaired locomotion, rapid wasting, fever, etc., 
are symptoms that may arise during the administration of this remedy 
in moderate doses. 

Iodul. — The disagreeable, penetrating, and diffusive odor of iodo- 
form has greatly restricted its 'use. The attempts made to overcome 
this inconvenient quality have not been satisfactory, and hence the 
attention of chemists has been turned in the direction of a substi- 
tute, which shall be possessed of the valuable powers of iodoform and 
free from its unpleasant odor. Iodol has been produced, and may be 
employed in all of the conditions for which iodoform has hitherto 
been prescribed. The new medicament is obtained by the action of 
iodine on certain constituents of animal oil. Its chemical name is 
Tetraiodopyrol. The proportion of iodine is quite large — about 85 
parts to 90 by weight — yet not equal to iodoform in this respect, 
which contains about 96 parts. 

Iodol occurs in the form of a grayish-white powder which darkens by 
exposure to light, is without odor, has very little taste, is readily soluble 
in alcohol, ether, and chloroform, but is almost insoluble in water. It is, 
however, quite soluble in the juices of the stomach, for its characteris- 
tic actions take place in a short time after its ingestion. The dose for 
internal administration will range from one fourth of a grain to five 
grains. It can be given in a wafer, in pill or pellet, or in simple powder. 

Although iodol contains somewhat less of iodine than iodoform, it 
parts with that constituent more readily, whence we conclude that it 
is quite as effective. Clinical experience confirms this view, for iodol, 
applied in all the morbid conditions heretofore treated by iodoform, 



IODINE AND IODIDES. 261 

has been found to be quite as useful. It is antiseptic, deodorant, and 
anaesthetic. Iodine liberated acts on the albuminous elements, and 
ozone set free oxidizes the compounds of sulphur and phosphorus. It 
has a feeble escharotic action, whence it forms a thin crust on the sur- 
face to which it is applied, and thus acts mechanically in part to re- 
tain the medicament in contact with the diseased surface. 

The proof that iodol diffuses throughout the organism is conclu- 
sive. Applied to a wounded surface, it can presently be detected in 
the saliva and in the urine, and the same results are obtained when it 
is administered by the stomach. As compared with iodide of potas- 
sium it is much less prompt in action, but more prolonged, and its 
elimination slower (Pick, Mazzoni). 

Experience has now shown that it is never necessary to administer 
a quantity of iodol that could cause toxic symptoms. Unlike iodo- 
form, no quantity, applied to an open wound, will have a toxic effect 
(Wolfenden). As a remedy, various modes of application have been 
proposed — as an impalpable powder, to be dusted on wounds, ulcers, 
etc., without any addition to it, or any vehicle. A solution in alcohol 
and glycerin, thus : iodol, 1 part ; alcohol, 16 parts ; glycerin, 34 parts, 
was proposed originally by Mazzoni, and much used by him as a topi- 
cal application. An ethereal solution ( 3 j — § j) has some advantage, 
in that when the ether evaporates, the medicament remains deposited 
in the minutest subdivision on the affected part. Various forms of 
applications are now resorted to — for example, iodol pastils, bougies, 
ointment ; iodol cotton, iodol gauze, etc., corresponding to those made 
with iodoform. 

Without repeating the various therapeutical details, it will suffice 
to say that iodol can be advantageously substituted for iodoform in 
the multiform applications of the latter which have had so much pro- 
fessional appreciation within a few years past. That iodol can effect- 
ively improve morbid conditions, appropriate for its action, is now 
admitted by all those who have had experience in its use. 

Authorities referred to : 

Carreras-Arago. Iodol in Ophthalmic Practice. Abstract in Virchow and Hirsch's 
Jahresbericht, 1886. 

Mazzoni, Marcus, and others, in Berliner Tclin. Woch. "Various Nos. for 1885 and 1886. 

Pick, Dr. J. P. Revue de Therapeutigue, May 15, 1887, p. 260. Ibid., 1885, 1886. 

Therapeutic Gazette. Therapeutics of Iodol, May 16, 1887. 

Schnirer, Dr. Bui. Gen. de Therap., February 15, 1887. 

Trousseau, Dr. Ibid. 

Wolfenden, Dr. R. N. The Praetitioner, vol. xxxviii, p. 336. 

Authorities referred to for iodoform, iodol, and ethyl iodide : 

Bellini, of Florence, and Renzi, of Naples. Controversy on the Action of Iodine, 
reported in V Union Medicate, No. 20, p. 481. 

Benedict, Dr. Moriz, Schmidt's Jahrbucher der gesammten Median, vol. cxv, p. 284. 



•262 RESTORATIVE AGENTS. 

Binz, Prof. Dr. C. Archiv fur pathohgische Anatomie und Phys. ( Virchoic's Archiv), 
Berlin, 1874, p. 124. 

Binz, Prof. Dr. C. Ueber Iodoform und uber Iodsaure. Archiv fur experiment. 
Pathologic und Pharmacologic, Band viii, p. 309. 

Culbertson, Dr. R. H. Therapeutic Gazette, March 15, 1885. 

Dreschfeld. Dr. Quoted by Dr. Shingleton Smith, in paper referred to below. 

Frankel, Dr. B. Berliner klinische Wochenschrift, ix, 6, 1 8*72. 

Hebra, Prof. Yon. Allg. Wien. med. Zeilg., vii, 3, 1862. Schmidt's Jahrbucher, vol. 
cxvii, p. 26. 

Herm ann, Dr. Jos. Die Nichtexistenz des constitutionellen Iodismus. Schmidfs Jahr- 
bucher, vol. cxii, p. 19. 

Hogtes, Prof. Andreas. Anmerkungen uber die physiologische Wirkung des Iodo- 
form und uber seine Umwandlung im Organismus. Archiv fur experiment. Pathologie 
und Pharmacologic, Band x, p. 228. 

Hutchison, Mr. Jonathan. Lancet, May, 22, 1875, p. 725. 

Izard, Dr. A. A. Nouveau Traite de la Malad. Ven. et des Syph. Ulcereuses par 
Vlodoforme, Paris, 1871. 

Kammerer, Prof. Dr. Hermann. Archiv fur path. Anat. und Phys., von Rudolph Yir- 
chow, 1874, p. 459. The article of Binz, above referrred to, was instigated by this paper. 

Kersch, Dr. S. Abstract in Virchoio und Hirsch's Jahresbericht for 1885. 

Kttster, Prof. Dr. Revue de Chirurgie, 1882, and Z' Union Medicate, August, 1882. 

Lawrence, Dr. New York Medical Journal, 1881, p. 685. 

Lindemann, Dr. Annuaire de Therapeutique, 1881, p. 269. 

Longuet, Dr. R. Le Proces de Vlodoforme. L 1 Union Medicale, No. 108, 1882. 

Mikulicz, Prof. Dr. Wiener med. Wochenschrift, quoted by Revue de Chirurgie, 
No. 7, 1882, p. 579. 

Moleschott, Prof. Dr. Ibid. 

Mosetig-Moorhof, Prof. Dr. Von. Ibid. 

Mundy, Prof. Dr. Berliner klin. Wochenschrift, No. 14, 1882, quoted by Z' Union 
Med., No. 125, 1882, p. 439. 

Poliakoff, Dr. London Medical Record for February 15, 1886. 

Rabuteau, Dr. Gazette de Paris, 14, 1869. Schmidfs Jahrbucher, vol. cxliv, p. 28. 
Ibid., vol. cxlv, p. 272. 

Rohmer, Dr. Du Pansement d Vlodoforme. Revue de Chirurgie, 1882. 

Rosenthal, Prof. Dr. Zur Kenntniss der Resorption und Absorption dcr lodprdparate. 
Wien. med. Woch., xiii, 1863. 

Rummo, Dr. Archives de Physiol, normale et pathol., Nos. 6 and 7, 18S5. 

Rummo and Renzi. London Medical Record, 1885. 

Sands, Dr. H. B. New York Medical Journal, November 12, 1882. 

Schede, Prof. Dr. Deut. med. Zeit., quoted by the London Medical Record, July 15,1 882. 

Schmidt, Dr. J. B. Berl. klin. Wochen., vii, 34, 1870. 

Smith, Dr. Shingleton. Paper read before the International Congress, at Copenha- 
gen, 1885. 

MERCURY AND ITS PREPARATIONS. 

Hydrargyrum.— Mercury. Mercure, Fr. ; Quecksilber, Ger. A sil- 
ver-white metal, liquid at common temperatures, and having the spe- 
cific gravity 13*5. T t is wholly volatilized by heat, and is dissolved 
without residue by nitric acid. 

Preparations. — Emplastrum Ammoniaci cum Hydrargyro. — 
Plaster of ammoniac with mercury. Composition : Ammoniac, 720 
parts ; mercury, 180 parts ; olive-oil, 8 parts ; sublimed sulphur, 1 part. 



MERCURY. 263 

Hmplastrum Hydrargyri. — Mercurial plaster. Composition : Mer- 
cury, 30 parts ; olive-oil and resin, of each, 10 parts ; lead-plaster, 
50 parts. 

Hydrargyrum cum Creta. — Mercury with chalk. Composition : 
Mercury, 38 parts ; prepared chalk, 50 parts ; sugar of milk, 12 parts. 
A gray powder partly dissipated by heat. When a small portion is 
treated with dilute acetic acid in excess, it is partly dissolved, nothing 
remaining but mercury in the form of minute globules not visible by 
a magnifying power of ten diameters. Dose, gr. ss — gr. x. Eight 
grains contain three grains of mercury. 

Massa Hydrargyri. — Pills of mercury. Blue mass. Composition : 
Mercury, confection of rose, and powered licorice-root. Three grains 
contain one grain of metallic mercury. Dose, gr. ss — gr. xv. 

Uhguentum Hydrargyri. — Mercurial ointment. Composition : 
Mercury, lard, suet, and compound tincture of benzoin. 

Hydrargyri Oxidum Flavum. — Yellow oxide of mercury. An 
orange-yellow powder, which, on being heated, assumes a red color ; 
then, if the heat be increased, it evolves oxygen, and finally the mer- 
cury evaporates without residue. 

Uhguentum Hydrargyri Oxidi Flavi. — Ointment of yellow oxide 
of mercury. Composition : Yellow oxide, 10 parts ; ointment, 90 parts. 

Oleatum Hydrargyri. — Oleate of mercury. Yellow oxide, 10 parts; 
oleic acid, 90 parts. 

Hydrargyri Oxidum Rubrum. — Red oxide of mercury. Red pre- 
cipitate. An orange-red powder, entirely soluble in muriatic acid. 
When heated it does not emit reddish fumes, but gives off oxygen, 
while the mercury either runs into globules or is wholly dissipated. 

Unguentum Hydrargyri Oxidi Hubri. — Ointment of red oxide of 
mercury. Composition : Red oxide, 10 parts ; ointment, 90 parts. 

Hydrargyri Subsulphas Flavus. — Yellow sulphate of mercury. 
Turpeth mineral. A lemon-yellow powder, sparingly soluble in water. 
It is entirely dissipated by heat, sulphurous acid being evolved, and 
globules of mercury sublimed. Dose, grs. ij — grs. v, as an emetic. 

Hydrargyri Chloridum Corrosivum. — Corrosive chloride of mer- 
cury. Corrosive sublimate. In colorless crystals or crystalline masses, 
which are fusible, and sublime without residue. It is entirely soluble 
in water (1 in 16), alcohol (1 in 7), and in 4 parts of ether. Lime- 
water causes a yellowish precipitate and ammonia a white one, from 
its solution. Dose, gr. ^ — gr. y 1 ^-. 

Hydrargyri Chloridum Mite. — Mild chloride of mercury. Calomel. 
A white powder, wholly volatilized by heat, and insoluble in water, al- 
cohol, and ether. With solution of potassa it yields a black precipitate 
of oxide of mercury, which is reduced by heat to the metallic state. 
Distilled water, after having been boiled with it, yields no precipitate 
with ammonia or nitrate of silver. Dose, gr. j^ — grs. x. 



204 AGENTS INCREASING WASTE. 

JPihdcv Antimonii Composites. — Compound pills of antimony. 
Pluminers' pills. Composition : Sulphurated antimony, calomel, and 
guaiae. Each pill contains one-half grain each of antimony and calo- 
mel, and one grain of guaiae. 

Hydrargyri Cyanidum.— Cyanide of mercury. In white prismat- 
ic crystals, soluble in 12*8 parts of water. When muriatic acid is 
added to the solution, hydrocyanic acid is evolved, made evident by 
its odor, and bichloride of mercury is left, which is entirely volatilized 
by heat. Dose, gr. ^— gr. f 

Hydrargyrum Ammoniatum. — Ammoniated mercury. White pre- 
cipitate. In white powder or pulverulent masses, decomposed and 
entirely dissipated by a strong heat, insoluble in water and alcohol, 
but dissolved without effervescence by muriatic acid. 

Unguentum Hydrargyri Ammoniati. — Ointment of ammoniated 
mercury. Composition : Ammoniated mercury, 10 parts ; benzoinated 
lard, 90 parts. 

Hydrargyri Iodidum Viride. — Green iodide of mercury. A green- 
ish-yellow powder, which becomes red when heated. It is insoluble 
in water and alcohol. Dose, gr. ^ — gr. j. 

Hydrargyri Iodidum Rubrum. — Red iodide of mercury. A red 
powder, which becomes yellow when heated, and red again when cold. 
It is wholly volatilized by heat, condensing in scales, which are at first 
yellow, but afterward become red. It is insoluble in water, but is dis- 
solved by boiling alcohol, and by solutions of iodide of potassium and 
chloride of sodium. Dose, gr. fa — gr. ^. 

Unguentum Hydrargyri Iodidi JRubri. — Ointment of red iodide 
of mercury. Composition : Red iodide, 5 parts ; ointment, 95 
parts. 

Hydrargyri Sulphidum Rubrum. — Red sulphuret of mercury. 
Cinnabar. In brilliant crystalline masses, of a deep-red color and 
fibrous texture. It is entirely volatilized by heat. When heated with 
potassa, it yields globules of mercury. It is not soluble in either nitric 
or muriatic acid, but is dissolved by a mixture of the two. Acetic acid 
which has been digested with it does not yield a precipitate with iodide 
of potassium. 

Liquor Hydrargyri JS^itratis. — Solution of nitrate of mercury. 
Mercury dissolved in nitric acid. Acid nitrate of mercury. " A trans- 
parent, nearly colorless, acid liquid, having the specific gravity 2*100. 
It is not precipitated by the addition of distilled water ; and the di- 
luted solution affords, with potassa, a dirty-yellow precipitate, and with 
iodide of potassium a bright-red one, soluble in an excess of the pre- 
cipitant. When dropped on a bright surface of copper, the dilated 
solution instantly deposits a coating of mercury." 

Unguentum Hydrargyri Nitratis. — Ointment of nitrate of mercury. 
Citrine ointment. 



MERCURY. 265 

Unguentum Hydrargyri Nitratis cum ol. Morhucz. — Not official. 
In the preparation of this ointment there are two steps : Solution No. 
1 is composed of cod-liver oil, 13 oz. ; lard, 3 oz. Solution No. 2 is 
made by dissolving 1J- oz. of mercury in 3 J ozs. of nitric acid. By a 
heat of 200° Fahr., the lard is dissolved in the oil. Both solutions are 
slowly mixed by stirring until thoroughly incorporated. 

Antagonists and Incompatibles. — Corrosive sublimate is incom- 
patible with alkalies and their carbonates, lime-water, tartar emetic, 
nitrate of silver, acetate of lead, albumen, iodide of potassium, soaps, 
various vegetable infusions, including cinchona. Calomel is incom- 
patible with the alkalies and alkaline earths and alkaline carbonates? 
with iron, lead, and copper. It should not be given in the same pre- 
scription with iodine (forms red iodide), and nitro-muriatic acid should 
not be prescribed in conjunction with it, lest corrosive sublimate be 
formed. There is little doubt, also, that calomel is converted into 
corrosive sublimate by the chlorides of sodium, potassium, and ammo- 
nium. The acids and acidulous salts are incompatible with hydrargy- 
rum cum creta. 

In cases of poisoning by mercurial salts, especially corrosive subli- 
mate, albumen, white of egg, wheaten flour, milk, etc., may be admin- 
istered. The white of one egg is considered sufficient for four grains 
of corrosive sublimate. An excess of albumen may redissolve the com- 
pound. Emesis should be promptly induced. 

Syneegists. — Depressing medicines, antimony, alkalies, especially 
alkaline chlorides, etc., promote the physiological activity of mercurials. 

Physiological Actions. — Metallic mercury in direct contact with 
the skin or mucous membrane is without action. Swallowed, it is pur- 
gative by virtue of its weight. If retained in the intestinal canal, it 
will form soluble combinations, enter the blood, and produce charac- 
teristic systemic effects. Similarly prolonged contact with the skin 
will be followed by the constitutional action of the drug. Injected 
into the veins, it will be arrested in the capillaries, producing the usual 
phenomena of capillary embolism. Mercury gives off vapors at the 
ordinary temperatures, which have, in notable instances, caused serious 
constitutional symptoms. As used in the mechanical arts, by gilders 
and others, the fumes of mercury cause wasting, ptyalism, necrosis of 
bones, trembling, impaired intellect, and in women, abortion. With- 
out producing such obvious effects as ptyalism, mercurial cachexia s 
eczema, and disease of the bones, obscure nervous phenomena may re- 
sult. Among these may be enumerated headache, loss of memory, 
trembling, defects of co-ordination, disorders of sensation, convulsions, 
and dementia. 

Mercury is readily absorbed — as a vapor by the pulmonary mucous 
membrane, when applied to the integument, or when taken into the 
alimentary canal. It probably exists in the blood as an albuminate. 



266 AGENTS INCREASING WASTE. 

Recent experiments (TVilbouchewitch, Keyes) have shown that mer- 
cury, as iron, manganese, and other metals, has the power to increase 
the number of red corpuscles, and to improve the quality of the blood, 
provided it is exhibited in small quantities, not often repeated. It has 
long been known (Liegeois) that this result followed the use of cor- 
rosive chloride in syphilis. Schlesinger has recently gone over the 
question anew with the same result, but he doubts whether the effects 
are really tonic. It remains true, however, that any considerable 
quantity of mercury, administered a sufficient time, will affect the 
quality and composition of the blood ; the red globules are diminished 
in number ; the fibrin loses its plasticity ; the proportion of water is 
increased, and various effete materials, whose nature is unknown, ac- 
cumulate. Mercury is deposited in all the textures, interferes with 
the normal nutritive processes, and is found in all the secretions and 
excretions. A marked degree of anaemia, loss of flesh, muscular weak- 
ness, intractable ulcerations of the skin, loss of hair, eczema, a foul 
breath, diarrhoea, the stools being very fetid, are the characteristic 
symptoms of the action of mercury on the solids and fluids of the body. 

This metal has a selective action on the lymphatic glandular sys- 
tem, and notably on the salivary glands and pancreas. Among the 
earlier symptoms of the action of mercury are an increase of the sali- 
vary secretion, an alteration of its quality, fetor of the breath, swol- 
len tongue, soreness of the teeth, a blue or dark slate-colored line 
along the margin of the teeth, sponginess of the gums, swelling of the 
parotid, sublingual, and submaxillary glands, aching of the jaws and 
teeth, with general muscular soreness and aching of the limbs, and 
some elevation of temperature. To this state are applied the terms 
acute ?nercuriaHsmus, ptyalism, in common language, salivation. 
Mercury certainly stimulates the pancreas ; this gland, like the sali- 
vary glands, becomes swollen, congested, and pours out an abundant 
secretion which, however, is not a normal but a pathological secretion. 
There is little doubt also that mercury increases the action of the in- 
testinal glandular appendages, and thus acts as a purgative. It not 
only increases the activity of these glands, but is itself in part ex- 
creted by them. The products of the increased waste of the tissues 
caused by mercury are also largely eliminated by the intestinal glands. 

Although calomel had been long known to act well in some cases 
of dropsy, especially when associated with squill and other diuretics, 
the untoward effects not infrequently observed — since known to be 
examples of renal dropsy with albuminuria — lessened confidence in its 
utility, and increased the distrust felt of all mercurials, against which 
a general revolt was rising. The experimental method and the growth 
of a truer scientific spirit have combined to revive confidence in the 
use of mercury, and hence the former belief in its diuretic power has 
been subjected to clinical trials by such observers as Leyden [Therap. 



MERCURY. 267 

Monatshefte of April, 1887], Rosenheim and Fttrbringer [Ibid], Wein- 
stein [Wiener med. Blatte, 1887], and Jendrassik [Deutsch. Archiv f. 
klin. Med., April, 1886], with many others. 

These recent experiences confirm the belief in the diuretic action of 
calomel, formerly an article of medical faith. The quantity required to 
act on the kidneys, and the conditions under which this physiological 
property is manifested, have been the subject of careful inquiry, and 
conclusions of a practical character have been reached. It is generally 
held by those most familiar with its diuretic action that the dose of 
three grains three times a day is about the quantity usually required. 
Experience has shown that more than this will cause diarrhoea or more 
serious trouble of the gastro-intestinal mucous membrane, and the 
danger of acute mercurialismus rises with the quantity administered. 

Although the diuretic property is an endowment of calomel per se, 
and is exerted under suitable conditions, it is quite certain that in the 
renal dropsies there is far more danger of ptyalism, and the explana- 
tion of this is afforded by the changes in the composition of the blood 
due to albuminuria. To prevent ptyalism, the use of potassium chlorate 
is practiced from the outset, and diarrhoea is prevented or restrained 
by the conjoint administration of opium. Such are the prophylactic 
measures suggested by some of those advocating the diuretic property 
of calomel, and who are mentioned above. Although anticipating 
somewhat, the author has to say that the combination of belladonna 
extract with the calomel has an excellent effect both to prevent diar- 
rhoea and ptyalism, and is more efficient in the latter, and is active 
enough, usually, to keep the former in due restraint. 

An explanation of the diuretic action of calomel maybe sought for 
in several directions. It is well known that purgatives often increase 
renal action by an influence reflex in mechanism. From the intestinal 
mucous membrane an impression is radiated by means of the solar 
plexus over the nerves of the renal system. If, however, the blood 
pressure is reduced by profuse watery evacuations, the kidneys do not 
act as strongly. It would seem, on first view, that the compound 
jalap powder acts in a manner opposed to the explanation just given, 
for it produces watery evacuations and also diuresis, but the renal 
action is a consequence of the bitartrate. 

The misconception of the action of mercurials on the liver has 
prevailed chiefly because of the peculiar evacuations produced by it. 
The true explanation of the nature of these stools has been given 
above, but the subject should not be dismissed without further refer- 
ence to the experimental work devoted to the elucidation of this subject 
within the past few years. The experiments of Rohrig, Rutherford, 
and Scott on animals, and the observations of Westphalen and Ranke 
in cases of biliary fistulae in man, have thrown a flood of light on the 
actions of mercurials, and there seems to be no longer any reason to 



268 AGENTS INCREASING WASTE. 

doubt the accuracy of the conclusions reached. It has been shown 
that calomel lessens the physiological activity of the liver, and conse- 
quently diminishes the production of bile. Instead of stimulating the 
liver, or acting as a cholagogue, calomel must be regarded as a seda- 
tive, and as having the power to allay an irritable state of the liver. 
Oddly enough, this fact harmonizes in the most satisfactory way with 
clinical experience, for calomel has always been regarded as useful in 
the highest degree in those cases of " biliousness," characterized by a 
surplusage of bile, due to an over-acting liver. Under such circum- 
stances an active cholagogue, stimulating the productive capacity of 
the organ, would only increase the existing complications. 

"While the sedative action of mercurials, including calomel and its 
congeners, on the hepatic functions has been established, by the same 
kind of investigation it has demonstrated that the corrosive chloride 
is to some extent a cholagogue increasing the production of bile (Ruth- 
erford), and as its stimulating action must include the glycogenic 
function as well, it may be supposed that its tonic and reconstituent 
power is thus produced. If we add to the cholagogue properties of 
mercury, which it possesses in common with resinous purgatives, the 
action on the pancreas and the increased elimination of the products 
of waste by the intestinal glands, we obtain a satisfactory explanation 
of those powers which have, under the term alterative, been heretofore 
ascribed to mercury. 

Mercury is eliminated by the salivary and the intestinal glands, by 
the liver, but chiefly by the kidneys. As a result of the changes in 
the composition of the blood, and of the direct action of the metal on 
the renal epithelium, albuminuria is one of the symptoms present in 
cases of mercurialism. Without the use of special means to render it 
soluble, and despite the use of such means, sometimes mercury remains 
permanently in the organism. When extremely severe cases of saliva- 
tion were not uncommon, permanent damage to the osseous structures 
often occurred, and globules of mercury could be shaken out of the 
dried bones of such subjects. Happily, nowadays, such cases do not 
occur. The moderate use of mercury, short of ptyalism, does not ap- 
pear to affect the human system injuriously. 

There are but few chronic affections of the nervous system not 
imitated in the multiform examples of chronic mercurialism. From 
the most trifling affections of sensibility and motility up to complete 
anaesthesia and paralysis, there are numerous gradations in the impor- 
tance of the lesions. From slight headache and impaired memory up 
to complete dementia there are, also, immense variations in the gravity 
of the mental and cerebral symptoms. The most frequently encount- 
ered nervous lesion is "trembling," and to this symptom more atten- 
tion has been given, from the period of Ktissmaul's elaborate essay, up 
to the present. 

It has been supposed, hitherto, that the mercurial trembling is ac- 



MERCURY. 269 

companied by muscular paresis, but recent observations have shown that 
this view of their absolute association is incorrect, the two conditions 
not necessarily being present together (Letulle). The paresis, which 
is usually more pronounced in the upper extremities, is not attended 
by trophic changes, as a consequence — the muscles flaccid, but not de- 
generating. At the beginning of the structural changes the reflexes 
are rather heightened, but, as the paresis increases, they decline. The 
electrical reactions are normal in character, but a quantitative decline 
sometimes occurs. Disorders of sensibility accompany the motor de- 
rangements. A characteristic of the disordered sensibility is its locali- 
zation to defined areas, the whole member not being affected, and the 
restriction to the extremities, the trunk remaining unaffected. The 
actual disorders of sensibility consist in lessening the tactile and pain 
sense, and in an aberration of the sense of temperature ; but rarely is 
there a complete abolition of the sensibility, and usually the changes 
are rather of a fugitive character. Corresponding disorders of func- 
tion appear in the organs of special sense, and are due to atrophic de- 
generation of the nerve-elements. Huskiness of voice, even complete 
aphonia, have been the result of paralysis of the laryngeal muscles. 

From the point of view of pathology, the motorial and sensory dis- 
turbances caused by mercury are due to a direct action on the proto- 
plasm of a destructive character, and in respect to the nerve-elements 
(Hallopeau) the initial changes occur in the most highly specialized. 
Like arsenic, lead, and other metals, mercury sets up a fatty degenera- 
tion of the gland-cells. 

Effects of the Different Preparations. — Hydrargyrum cum 
creta, calomel, and blue-pill are very similar in action. Calomel, being 
insoluble, probably escapes solution and combination in the stomach, 
and is decomposed by the alkaline contents of the small intestine, the 
oxide of mercury being precipitated. It follows, from this reaction, 
that the effects of blue-pill and calomel must be similar, and in practice 
it is found that they correspond closely therapeutically. Salivation 
more frequently results from the use of blue-pill than from the other 
mercurials ; and calomel comes next in point of activity in this respect. 

The corrosive chloride, the red iodide, and the cyanide, are pow- 
erful irritant and corrosive poisons. When a poisonous dose of cor- 
rosive sublimate has been swallowed, the mucous membrane of the 
mouth has usually, but not invariably, a whitish, glazed appearance, 
as if it had been washed over with a strong solution of the nitrate of 
silver. A sense of constriction of the throat and a strong styptic and 
metallic taste are experienced. The toxic symptoms follow in a few 
minutes the ingestion of the poison. Usually, violent pain is felt in the 
abdomen, but this is not invariable. Vomiting follows, and the vom- 
ited matters consist at first of the contents of the stomach, and after- 
ward of mucus streaked with blood. There are usually purging, tenes- 
mus, intestinal cramp, and not unfrequently dysenteric discharges. 



070 AGENTS INCREASING WASTE. 

These evidences of violent gastro-intestinal irritation are accompanied 
by small, weak pulse, coldness of the surface — but sometimes by a 
swollen and flushed face — sighing respiration, syncope, insensibility, or 
convulsions. If the patient survive a few days, ptyalism may occur. 

The following are the symptoms of chronic poisoning stated in the 
most concrete form : abdominal pains ; nausea ; vomiting ; dysenteric 
diarrhoea ; general weakness, trembling, or paralysis, and other nerv- 
ous affections ; ptyalism ; fever ; emaciation, etc. There sometimes 
occurs a blue line along the margin of the teeth, not unlike that pro- 
duced by lead. Suppression of urine is a not infrequent symptom 
in acute poisoning, and albuminuria is very often present in cases of 
chronic mercurialismus. 

The corrosive chloride and the red iodide of mercury are the most 
powerful antiseptics and germicides now available. Their germicide 
powers have been made the subject of investigation in the only way 
that such a question can be determined — by ascertaining the degree 
and character of their effects on cultures of the pathogenic organisms. 
To Miguel, De la Croix, Bucholtz, and others in Europe, and to Stern- 
berg and Welch in this country, we owe the very accurate knowledge 
now possessed of the character and limits of the germicide power. 
Any difference that exists between the chloride and iodide, in respect 
to their power to destroy disease-germs, is in favor of the latter 
(Miguel). An effective germicide is destructive not only of the organ- 
ism but of its ova. Experience has demonstrated that the germ — the 
microbe — may be killed and yet the ova resist the action of the germi- 
cide and hence pullulation goes on as actively as before. No antisep- 
tic is entitled to be so designated unless its power is equal to the de- 
struction of the organism and of its ova also. 

Therapy. — The acute glandular affections of throat and neck — 
tonsillitis, parotitis, inflammation of the submaxillary and sublingual 
glands — are often speedily removed by mercurial preparations. The 
one twentieth of a grain of calomel, or the one fifth of mercury with 
chalk, may be given every two hours, or one minim of the following 
solution may be administered at the same interval : I£ Hydrarg. chlor. 
corrosiv., gr. j ; aquae, 3 j. M. Sig. : Dose, nr, j. Chronic affections 
of these organs are not benefited by these remedies, and the so-called 
scrofulous diseases of the cervical glands are made worse by them. 

Corrosive sublimate is an effective remedy in gastric ulcer. The 
thirtieth to the sixtieth of a grain, three times a day before meals, is a 
proper quantity and occasion for this purpose. Certain kinds of vom- 
iting are quickly cured by small doses of calomel. The vomiting of 
children, caused by indigestible food or by constipation, or by these 
causes combined, is often speedily relieved by one-twelfth-of-a-grain 
doses of calomel every half -hour or hour, dropped on the tongue. This 
remedy is the more efficacious when such vomiting is accompanied by 



MERCURY. 271 

great heat of head, restlessness, and fever. The vomiting of cholera 
infantum is often stopped by the same means. 

It has long been held that mercurials are specially indicated in that 
catarrhal state of the intestinal mucous membrane and of the hepatic 
duct, manifested by nausea, anorexia, tympanites, whitish or clay-col- 
ored stools, and jaundice. The use of mercury in these cases is predi- 
cated on its supposed power to promote the flow of bile. It is true, 
no doubt, that calomel and blue-pill will remove these symptoms, but 
such mild salines as phosphate of soda, sulphate of magnesia, tartrate 
of soda and potassa, etc., will usually succeed quite as well and with- 
out detriment to the patient. The diarrhoea and dysentery of infants 
(ileo-colitis) is frequently treated by minute doses of calomel or hy- 
drargyrum cum creta. When there are much straining and bloody 
mucus, it is said that small doses of corrosive chloride prove very 
effective, but the author is convinced that mercurials are much abused 
in these affections. Children are quickly poisoned by mercurials, al- 
though they are not easily salivated. The spinach-colored stools 
which so frequently occur in the summer complaint of children, and 
which are, by ignorant practitioners, supposed to be produced by the 
mercury administered, really belong to cases of ileo-colitis, and may, 
by their persistence and profuseness, signify an increased irritation of 
the intestinal mucous membrane due to the remedies given. While 
the author believes that other medicines are more useful than mercury 
in the ileo-colitis of children, he is convinced of the utility of minute 
doses of calomel (one twentieth to one twelfth of a grain every half- 
hour) when there is much irritability of the stomach. Mercurials are 
contraindicated in the diarrhoea and dysentery of adults, as a rule. 

It was formerly an article of faith to hold that mercury was a sov- 
ereign remedy in hepatic disorders. The state known as biliousness, 
characterized by a yellowish-coated tongue, yellow conjunctivae, muddy 
skin, nausea, constipation, may be removed by a mercurial purge when 
these symptoms are due to catarrh of the duodenum, excesses of the 
table, sudden checking of the perspiration, etc. The blue-pill, or 
mercury with chalk, or calomel, succeeds in these cases by removing 
offending substances from the intestinal canal, by relieving a catarrh- 
al state of the mucous membrane, or by causing elimination of waste 
products by the intestinal glandular apparatus. Less objectionable 
agents may be employed with equal success. 

The experience of the India medical officers has shown conclusively 
that mercurials are harmful in acute hepatitis, hepatic abscess, jaundice 
from gall-stones, acute yelloio atrophy, etc. As these affections are 
very rife in India, an experience which has led to such conclusions 
should be heeded. There is no evidence to show that mercurials ren- 
der the least service in cirrhosis. 

Calomel is a very efficient purgative. It will be retained when 



272 AGENTS INCREASING WASTE. 

other purgatives are rejected by the stomach ; it is free from taste, 
and may therefore be given easily to children. When it operates, 
nausea and tormina may be experienced. One grain of calomel at 
night will act in the morning, and not unfrequently a half-grain will 
give satisfactory results. A full purgative dose of calomel (five grains) 
is an excellent vermifuge for the lumbricoid worms. It may be given 
with santonine. At the onset of acute febrile diseases, calomel is a 
useful purgative ; it hastens waste, and causes the elimination of the 
products by the intestine. 

Mercurials were formerly much esteemed in the treatment of acute 
inflammation, especially of serous membranes. As calomel — the mer- 
curial preparation usually employed — was combined with opium, it was 
not known to which remedy the good results were due, but the mer- 
curial was considered to have the larger share of merit. It is now 
admitted that opium was the effective agent. An apparent exception 
to this statement exists in the case of iritis, a disease in which the 
good effects of mercury are most conspicuous ; but iritis, probably, is 
always of syphilitic origin, and, in syphilitic inflammation of serous 
membranes, it is not disjmted that mercurials are extremely efficacious. 
In these days, however, although opium is considered indispensable in 
peritonitis, pleuritis, pericarditis, etc., mercury is no longer combined 
with it. No longer is it considered necessary to " touch the gums " 
in order to cure a serous inflammation, and only the most prejudiced 
and benighted practitioners insist in the use of mercurials in these in- 
flammatory affections. 

Large doses of calomel — five grains every four hours — are said to 
be very efficacious in true croup or membranous laryngitis. It is 
claimed that it allays spasm and checks the formation of the false 
membrane. The author is skeptical in regard to the utility of calomel 
in this affection. There is, however, no doubt as to the value of the 
yellow subsulphate (turpeth mineral) as an emetic in this disease. If 
given early, it is the doubtful statement of Dr. Fordyce Barker, of New 
York, that a fatal result will most certainly be averted. From two 
to four grains of the subsulphate may be given as an emetic for a child 
with croup. Serious results might be produced by this dose if emesis 
did not so promptly follow. The powder comes up w T ith the contents 
of the stomach, in from five to fifteen minutes after being swallowed. 
But little depression follows the emesis produced by turpeth mineral, 
in which respect it has a decided advantage over sulphate of cop- 
per, tartar - emetic, and even ipecacuanha. As it is insoluble, this 
remedy should be rubbed up with sugar and placed on the base of 
the tongue. 

Corrosive sublimate has lately been used with very distinct advan- 
tage in the treatment of diphtheria. Its remarkable germicide prop- 
erty is the motive for its employment, and clinical experience strongly 



MERCURY. 273 

supports the results of experiment. The dose administered in the 
treatment of diphtheria will range, according to the age of the sub- 
ject, from yJtj grain to ^ grain every four or six hours. 

Liebermeister, following the lead of Traube, Wunderlich, and others, 
has obtained surprising results from the use of calomel in typhoid fever. 
By our German confreres this treatment is called the specific treatment 
of abdominal typhus. It consists in the administration of ten grains 
of calomel in a single dose the first day, and eight grains a day for 
three or four days thereafter. It is a curious fact that these large 
doses of calomel have an antipyretic effect. According to the statis- 
tics of Liebermeister, the " specific " calomel treatment shortens the 
duration and lessens the mortality from typhoid fever, as compared 
with the non-specific, expectant, or other plans of medication. 

Calomel is one of the numerous remedies used in the treatment of 
cholera Asiatica. Two methods are pursued : large doses at consider- 
able intervals ; small doses frequently repeated. The latter method is 
nowadays much more usually practiced. In consists in giving every 
fifteen minutes, half -hour, or hour, the one sixth, one half, or one grain 
of calomel, combined with opium, chalk, piperine, etc. The author, 
who has had considerable experience in the treatment of cholera, can 
not express any degree of confidence in the efficacy of this treatment. 
Large doses (a scruple to a drachm) sometimes appear to arrest vomit- 
ing when other means fail, but there is danger of excessive ptyalism 
when reaction sets in. 

The most important application of mercury therapeutically is in 
the treatment of syphilis. It may be regarded as a specific in this dis- 
ease. The reaction which set in against its use a few years ago has 
certainly led to important modifications in the mode and quantity in 
which mercury should be given ; but the fact has been conclusively 
established that mercury in a certain sense is antidotal to syphilis. 
As mercury arrests the proliferation of the syphilitic virus in the blood, 
this agent should be used with the earliest manifestations of the specific 
character of the infecting sore. Mercury is npt indicated in chancroid, 
or non-infecting chancre, and should not be used. If the chancre have 
the characteristic quality of the infecting sore, small doses of one of 
the mercurial preparations should be begun and continued steadily 
until all induration has disappeared. The important point is, not to 
induce ptyalism. It is now conceded that the danger of a relapse will 
be very much lessened by continuing the mercurial treatment for some 
time — for several months — after local manifestations have ceased. 
The ill effects of a mercurial course may be prevented by the use of 
small doses, by careful attention to hygiene, and by lessening the dose, 
or discontinuing the remedy entirely, whenever soreness of the jaws 
can be developed by smartly closing the teeth. By the adoption of 
these precautions, a mercurial course may be continued without im- 
19 



27-t AGENTS INCREASING WASTE. 

portant interruptions until the period of incubation has entirely passed, 
and through the so-called secondary or constitutional stage. 

Various methods are resorted to for the introduction of mercury 
Into the organism : 

1. Inunction. — Before practicing inunction, the patient should take 
a warm bath, or, at least, wash the part to be operated on with soap 
and water. From fifteen to thirty grains of mercurial ointment is the 
quantity required for each inunction. The oleate of mercury in pro- 
portion of fifteen to thirty per cent in the solution may be substituted 
for the ointment, but the oleate is to be applied with a brush, and not 
be rubbed in. Sigmund, the great advocate for the inunction method, 
has prescribed certain rules, which should be followed. The ointment 
should be rubbed in with moderate friction by the palm of the hand : 
on the first day on the legs ; on the second day on the thighs ; on the 
third day on the abdomen and sides of the chest ; on the fourth day 
on the back ; on the fifth day on the arms. Mercurial inunctions are 
not borne equally well by all patients. Some are easily salivated, and 
others suffer from eczema or erythema. Moreover, the inunction treat- 
ment is filthy and troublesome, and it should, therefore, be restricted 
to those cases in which mercurials are badly borne by the stomach. 

2. Fumigation. — Various mercurial preparations may be used — the 
sulphuret, the iodide — but calomel is the best. The apparatus consists 
of a spirit-lamp, a plate to hold the calomel, surrounded by a shallow 
vessel containing water, a blanket large enough to cover the patient 
and the apparatus. The calomel is volatilized by the heat of the lamp, 
and is deposited, together with the vapor of water, on the skin of 
the patient. About fifteen minutes is the time required for the bath, 
and the quantity of calomel used ranges from eight to fifteen grains. 
The method of fumigation is especially adapted to cases of the con- 
stitutional, or secondary, and to the tertiary, with ulcerations, when 
the state of the patient is such as to forbid the internal administration 
of mercurials. 

3. Hypodermatic Method. — This consists in the introduction under 
the skin of corrosive chloride, or albuminate of mercury. t> Hydrarg. 
chlor. cor., gr. j; glycerini, 3 j; aqua3 destil., 3 j. M. Sig. : Ten min- 
ims a dose once a day. This method is cleanly, quick in results, and 
more successful than any other in preventing relapses. 

The peptonate of mercury, as advocated by Bamberger, has been 
much employed lately for the treatment of syphilis by the subcutane- 
ous method ; but the albuminate alone, without pepsin, is both more 
effective and less likely to set up local inflammation. The following 
formula for the preparation of albuminate of mercury, recommended 
by Gourgues, is probably the best now available for this purpose : 
Bichloride of mercury, gr. xv ; distilled water, 3 v. To this solution 
is added five drachms of white of egg, and, after thorough shaking, 



MERCURY. 275 

the mixture is incorporated with the following : Chloride of sodium 
(common salt), gr. xxx ; distilled water, f | ij. This mixture is then 
well agitated, and afterward filtered, after which sufficient distilled 
water is added to make the solution up to four fluid ounces. The dose 
of this solution for hypodermatic injection is from t\[ xv — 3 ss. When 
finished, the solution is not clear, but rather semi-transparent ; but it 
remains longer and better in solution than most of these prej:>arations. 
The peptonate of mercury is not only variable in composition, but 
easily undergoes change, and is liable to produce violent local irrita- 
tion. The albuminate prepared as above suggested is readily admin- 
istered, is not painful, and is rarely followed by unpleasant accidents 
at the site of the injection. As regards the results of the administra- 
tion on the progress of the disease, they are remarkable (Gourgues). 
According to Martineau, the hypodermatic mercurial treatment exer- 
cises on syphilis in its various manifestations an action much more 
effective, more energetic, and more rapid, than any other method hith- 
erto proposed. The subcutaneous areolar tissue of the back is the best 
place for the injections. The number of them and the quantity of 
fluid used will depend on the stage of the disease, the severity of the 
manifestations, and the condition of the patient. 

Besides the preparations above mentioned, other solutions of corro- 
sive chloride have been proposed. Matthes recommends the follow- 
ing : Bichloride of mercury, gr. xv ; chloride of sodium, gr. xxx ; dis- 
tilled water, f f iij. Make a solution. Matthes had observed the 
action of this during two years at Auspitz's polyclinic. The usual dose 
was a Pravaz syringeful — fifteen to twenty minims — every two days. 
No irritation is produced beyond some tumefaction, and, in general, 
twenty to thirty injections sufficed to effect a cure. 

Recently, Liebreich has brought forward the formamide of mer- 
cury as the most suitable preparation for the hypodermatic method. 
It is neutral in reaction, readily soluble in water, and does not coagu- 
late albumen. 

4. Internal. — This method, in the nature of things, must be most 
frequently resorted to. Various mercurial preparations are used by 
different syphilographers. The Bicord school prefer the green iodide ; 
Sigmund, mercurial-ointment inunctions ; Foerster, the yellow iodide ; 
Berkeley Hill, the red iodide ; Tilbury Fox, the cyanide ; Bumstead 
advises mercurial pill, the green iodide, the bichloride, according to 
circumstances, but his preference is for the use of calomel by fumi- 
gation. That preparation of mercury is to be preferred which best 
agrees with the patient, is the rule. 

The indications for the use of iodine preparations have already been 
stated, but it may be useful, now, to place in juxtaposition the com- 
parative utility of mercury and iodine : mercury for the primary in- 
fecting sore ; mercury for the affections of the skin, especially macular 



•:;0 AGENTS INCREASING WASTE. 

and papular exanthemata ; iodine for the tertiary symptoms : gummata ; 
tubercular syphilides ; serpiginous ulcers ; affections of the bones and 
periosteum, and nervous diseases. 

Hydrargyrum cum creta is usually preferred for the treatment of 
congenital syphilis. Mr. Marshall recommends the twenty-per-cent 
ointment (the size of a pea) of the oleate of mercury, to be placed in 
the axilla night and morning for five or six days. 

Local Uses of Mercurials. — Recent experimental investigations on 
the action and comparative germicide properties of the various anti- 
septics have shown the superiority of corrosive sublimate over all 
others ; hence it has come to be largely used in the dressing of wounds, 
and as a local application to specific ulcerations, etc. The acid nitrate 
of mercury is one of the best caustics for the destruction of chancroid. 
It should be applied with a glass rod after the surface of the sore 
has been well cleansed. It is now conceded that destruction of an 
infecting chancre does not prevent systemic infection. Syphilitic 
icarts and vegetations on the genitals are amenable to the same treat- 
ment. Erosions and ulcerated indurations are best treated by 
"black -wash" (calomel, eight grains — lime-water, one ounce), or 
" yellow-wash " (one grain of corrosive sublimate to an ounce or two 
of lime-water). The surface of the sore may be kept wet with these 
lotions. 

Ricord's treatment of condylomata consists in washing them with 
a solution of chlorinated soda, and then dusting them with calomel. 
Mercurial applications are of very great service in cutaneous affections 
of syphilitic origin. A drachm of calomel to an ounce of lard makes 
an ointment which is very serviceable in herpes, psoriasis, and pruritus 
of the vulva and anus. Ringer speaks of calomel-ointment in terms 
of great praise in various itching affections, especially of the anus and 
perinseum. In acne, lotions containing corrosive sublimate, and oint- 
ments of green and red iodide, are much employed : t> Hydrarg. 
chlor. cor., 3] ; glycerini, § ss ; spts. vini rect., § vij ; spts. rosmar., 
3 iv. M. For acne and pityriasis of the scalp : r> Hydrarg. iod. 
virid., gr. x ; adipis, § j. M. £} Hydrarg. iod. rubri, gr. v ; adipis, 
1 j. M. For acne indurata. The following is Startin's lotion of 
corrosive sublimate for syphilitic eruptions : r> Hydrarg. chlor. cor., 
gr. iv ; acid, nitric, dil., 3 j ; acid, hydrocyan. dil., 3 j ; glycerini, 3 ij ; 
aquas, 1 viij. M. F 'or pityriasis, chloasma, etc. 

Lotions of corrosive sublimate are much employed in the treatment 
of parasitic skin-affections. The stronger ones must be used with cau- 
tion. It is rarely necessary to use a lotion stronger than two grains to 
the ounce. The following is an excellent formula of Tilbury Fox : 3 
Hydrarg. chlor. cor., grs. iv ; alcohol, 3 v j ; ammonias muriat., 3 ss ; 
aquas rosse, q. s. ad f vj. M. For scabies, ptheiriasis, and tinea versi- 
color. A scruple of corrosive sublimate to the ounce of simple oint- 



MERCURY. 277 

ment is an effective application in favus and tinea tonsurans, when 
used in the early stages of these affections. 

Calomel finely levigated and dusted over the membrane by means 
of a camel's-hair brush is an excellent local application in phlyctenular 
ophthalmia. Eczema of the margin of the eyelids is quickly cured by 
rubbing in every night, after detaching the scales, a small quantity of 
the brown citrine-ointment. Chronic inflammation of the external 
auditory meatus is cured by the same application, viz ., by allowing a 
small quantity of the brown citrine-ointment to remain in contact with 
the integument. 

Mr. Marshall strongly recommends the oleates in parasitic skin-dis- 
eases. He employs a five-per-cent solution of oleate of mercury in 
oleic acid, adding an eighth part of ether. This is applied by means 
of a camel's-hair brush. It is used in sycosis, tinea, and chloasma, 
porrigo, pruritus ani, and pruritus pudendi. The oleates are extremely 
serviceable remedies for the local treatment of syphilitic induration, 
but they are not advisable when ulceration exists. 

The oleate of mercury and morphia (obtained by the addition of 
the alkaloid morphia) is an elegant and efficient application in super- 
ficial inflammations, especially of joints of the rheumatic and arthritic 
varieties. Inflammatory indurations, left after the subsidence of acute 
trouble, are removed by the same combination. For application to 
these purposes Mr. Marshall employs a five-per-cent, ten-per-cent, and 
twenty-per-cent solution of oleate of mercury in oleic acid. To every 
drachm of such solution he adds one grain of morphia. 

Mr. C. Bader, the eminent ophthalmologist of London, advises the 
following ointment in conjunctivitis: IjL Hydrargyri oxidi rubri, 
gr. x; atropia? sulph., gr. j ; vaselin., § j. M. Dr. Seely, of Cincin- 
nati, strongly urges the use of an ointment of the yellow oxide, eight 
or ten grains to the ounce of vaseline. He directs that the yellow 
oxide be triturated to the utmost degree of fineness, and then thor- 
oughly incorporated with the vaseline, the result being a bright-yellow 
ointment. A portion of this is taken on a probe, the lid lifted up, and 
the whole is wiped off on the mucous membrane. 

For pruritus of the vulva, the following lotion is recommended : 
Hydrarg. chlor. cor., one part ; alum, 20 parts ; starch, 100 parts ; and 
water, 2,500 parts. The official ointment of the red iodide of mercury 
is an effective application in simple hypertrophy of the thyroid gland, 
and an enlarged spleen, or ague-cake. A bit of ointment, the size of 
a large pea, is thoroughly rubbed in over the affected organ, the sun's 
rays falling on the part if practicable, or the friction may be carried 
on before a bright fire, or without. As soon as the skin becomes sore 
the applications are susj)ended until it recovers, when they may be re- 
sumed. The applications should be made daily. 

For that parasitic affection of the skin, pityriasis, there is no lotion 



278 AGENTS INCREASING WASTE. 

so effective as a strong solution of corrosive sublimate — 3 j — 3 j — § iv 
of rose-water. It need hardly be observed that these strong solutions 
require very careful handling. Less than necessary will fail, and appli- 
cation to an abraded surface will induce toxic symptoms. 

As a germicide, corrosive sublimate now occupies the first place, and 
is, in consequence, largely utilized in medical, surgical, and obstetrical 
practice. In parasitical diseases, as diphtheria, typhoid, gonorrhoea, 
etc., excellent results have been obtained by its use (Paul, Martineau, 
Moutard-Martin). To destroy the infection of wounds, to sterilize in- 
struments, to remove decomposing materials, and to prevent systemic 
poisoning, corrosive sublimate continues to be employed on an increas- 
ing scale — only limited by the danger of its toxic action. It must be 
remembered that this danger is by no means remote. An early mani- 
festation of toxic action is the occurrence of enteritis, examples of which 
have been recently published by Fraenkel, Peabody, and others, when 
a solution of one part to one thousand only had been applied topically. 
Well-authenticated instances of toxic effects have become so numer- 
ous as to demand intelligent supervision during the whole period of 
its application. 

Authorities referred to : 

Anderson, Dr. McCall. On the Treatment of Diseases of the Shin, London, 1872. p. 98. 

Baumler, Prof. Dr. Christian. Ziemssen's Cyclopcedia, vol. iii, p. 280, American edition. 

Bucholtz, Dr. Archivf. experiment. Pathol, u. Pharm., Band 4, p. 1. 

Bumstead, Dr. Freeman J. On the Pathology and Treatment of Venereal Diseases. 

Fox, Dr. Tilbury. On Diseases of the Skin, Syphilodcrmata, p. 2*7*7, second Amer. ed. 

Fraenkel, Dr. Virchow und Hirsch, Jahresbericht for 1885. 

Gombault, M. Arch, de Nevrologie, vol. i, 18S0. 

Hallopeau, M. Archives, de Phys. et Path., p. 140, 1878. 

Hermann, Prof. Dr. L. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 211. 
QuecTcsilbersalze. 

Kussmaul, A. Untersuchungen uber den constit. Mercurialismus (quoted). 

Lancereaux, Dr. E. Treatise on Syphilis. Sydenham Society edition, vol. ii, p. 291. 

Letulle, M. Recherches din. et exper. stir les Paralys. Mercurial. Archives de Phy- 
siol, etc., No. 3, 1887. 

Marechal, Ph. TJifae de Paris, 1886 (quoted) 

Marshall, Mr. John, F. R. S. The Lancet, vol. i, 1872, p. 709. 

Martineau, Dr. Therapeut. Society Discussion, 1885. In Revue de Therap. ; Bui. 
Gen. de Therap., and other periodicals. 

Miguel, Dr. Bui. Gen. de Therap., vol. cvii, p. 80. 

Moutard-Martin, Dr. Ibid. 

Nothnagel, Prof. Dr. Hermann. Handbuch der Arzneimiitellehre, p. 225. 

Paul, Dr. C. Ibid. 

Peabody, Dr. New York Medical Record for 1885. 

Ross, Dr. James. On the Action of Mercury. The Practitioner, vol. v, p. 211. 

Rutherford, Prof. William. An Experimental Research on the Physiological Actions 
of Drugs on the Secretion of Bile, Edinburgh, 1880. 

Schmidt's Jahrbucher. Ueber subcuiane Injection von Quecksilberpraparaten bei 
Syphilis, vol. cliii, p. 153. Abstract of papers and works by Hansen, Taylor, Schutzen- 
berger, Caspari, Paqvalin, Lewin, Sigmund, etc. 



GOLD. 279 

Scott, Dr. George. Beetle's Archives of Medicine, vol. i, p. 209. 

Taylor, Dr. A. S. Treatise on Poisons, p. 39*7, American edition. 

Taylor, Dr. R. W. Bone Syphilis in Children, New York, 1875, p. 155. 

The Edinburgh Committee, British Medical Association. On the Cholagogue Ac- 
tion of Mercury. Medical Times and Gazette, vol. ii, 1869, p. 418. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere Medicale, huitieme edi- 
tion, vol. i, p. 228. 

Aurum. — Gold. Or, Fr. ; Gold, Ger. 

Auri Chloridum. — Chloride of gold. (Not official.) Needle- 
shaped prisms of a beautiful yellow color, deliquescent, freely soluble 
in water. Dose, gr. £>— gr. T V 

Auri et Sodii Chloridum. — Chloride of gold and sodium. An or- 
ange-colored salt, crystallizing in four-sided prisms, soluble in water. 
Dose, gr. -fo— gr. ^ 

Antagonists and Incompatibles. — Eggs, albumen, milk, flour, are 
chemical antidotes. The contents of the stomach should, of course, 
be evacuated. The principles of treatment are the same as for poison - 
ing by corrosive sublimate. 

Synergists. — The salts of mercury, especially the corrosive chloride, 
are very similar in action to the chlorides of gold, and are therefore 
synergistic. 

Physiological Action. — The chloride of gold is a caustic in its 
local action. In toxic dose it excites violent gastro-enteritis, accom- 
panied by such nervous phenomena as cramps, convulsive trembling, 
insomnia, priapism, insensibility, etc. In small medicinal doses these 
auric preparations promote the appetite and the digestive capacity. If 
long continued, especially if the dose be a full medicinal one, epigastric 
pain and distress are excited, nausea is induced, and loss of appetite 
follows. Constipation is usually produced by the preparations of gold, 
and this, notwithstanding an increased secretion of the intestinal 
glandular apparatus is one of the results of their administration. 
These preparations do not probably entirely enter the blood from the 
stomach, but part passes to the intestinal canal, is there decomposed, 
and is absorbed as oxide in combination with albumen. This is, how- 
ever, conjectural. They are readily soluble and are very diffusible 
substances. What particular influence they exert on the composition 
and function of the blood is at present quite unknown. A form of 
fever, known as auric fever, is caused by their prolonged adminis- 
tration. This fever is accompanied by profuse sweats, a very abundant 
flow of urine, and increased salivary secretion. The salivation caused 
by the preparations of gold differs from the mercurial in that there is 
no tenderness nor ulceration of the gums. 

Peculiar effects on the mental state are produced by the adminis- 
tration of the auric preparations. The functions of the mind become 
more active, and even excited, and a state of cheerfulness is induced. 
In men, marked aphrodisiac effects are produced, and the erections are 



280 AGENTS INCREASING WASTE. 

often painful ; in women, increased venereal desires and augmentation 
of the menstrual flow are observed. 

The elimination of the auric preparations takes place by the liver, 
the intestinal canal, but chiefly by the kidneys. The urine assumes a 
bright-yellow color. 

Prolonged administration of medicinal doses induces epigastric heat 
and oppression, headache, dryness of the throat and mouth, gastro- 
intestinal irritation, fever. 

Therapy. — The chloride of gold and sodium, in small doses (^ 
grain) three times a day, will relieve nervous dyspepsia. A red and 
glazed tongue, epigastric pain, increased by taking food, and a tend- 
ency to relaxation of the bowels after eating, are indications for the 
use of this salt. Catarrh of the duodenum, catarrh of the bile-ducts, 
and jaundice dependent thereon, are symptoms which may usually be 
removed by the salts of gold if given in small doses. 

These preparations are employed chiefly in the treatment of syphilis, 
secondary and tertiary. They are indicated in the same cases in which 
corrosive sublimate is effective. 

In certain convulsive neuroses of the resjDiratory organs, the 
chloride of gold and sodium has seemed to be very effective ; for ex- 
ample in laryngismus stridulus, whooping-cough, etc. 

Ame?iorrho3a, dependent on torpor of the ovaries, may be removed 
by the persistent use of auric preparations. Chronic metritis, with 
scanty menstruation, is often remarkably benefited by them. Sterility, 
dependent on these states, or due to coldness, is more certainly cured 
by these agents than by any other merely medicinal means. It is said 
by Martini that the tendency to habitual abortion may be averted 
by the use of chloride of gold. 

Decline of the sexual power in man may be prevented by the use 
of gold salts, and the following are symptoms which may be removed 
sometimes by them : diurnal seminal losses, weak and inefficient erec- 
tions, inability for the sexual congress, due to irritability of the sexual 
organs. They increase the frequency of the nocturnal losses in those 
who are suffering from plethora of these organs. Cases that are 
benefited by the bromide of potassium are increased by the chloride 
of gold, and vice versa. 

The author calls especial attention to the use of the salts of gold in 
chronic BrigMs disease — granular and fibroid kidney. His experience, 
narrated in successive editions of this work, has continued to be highly 
favorable, and various confirmatory observations have been published 
by others. The double chloride — of gold and sodium — is the prepara- 
tion to use, and the dose will vary from T V— A" grain. 

The nature of the curative action consists in the impression made 
on the connective-tissue elements ; it prevents or lessens the over- 
growth, and hence it is now utilized in the treatment of the various 



SILVER. 281 

scleroses — of the liver, of the kidney, of the arterial system {arterio- 
sclerosis), and of the nervous system. 

Excellent results are obtained from the use of the double chloride 
in certain forms of mental disorder : e. g., melancholia, hypochondria, 
and allied mental states, accompanied by depression. Vertigo and 
vertiginous sensations, when due to stomach-disorders, are often re- 
moved by minute doses, but plethora and increased intracranial blood- 
pressure contraindicate their use ; on the other hand, they have a 
high degree of utility when there is present the condition of cerebral 
anaemia. The author has been favored with a private communication 
from Dr. Bauduy, of St. Louis, in which this experienced and able 
physician expresses his confidence in the value of this remedy in the 
treatment of hypochondriasis and melancholia. In Chaucer's " Can- 
terbury Tales," which appeared near the close of the fourteenth cent- 
ury, we find the following couplet : 

" For gold in physic is a cordial, 

Therefore, he loved gold in especial." 
Also, in that curious mixture of scholastic learning and whimsical 
suggestion, the " Anatomy of Melancholy," gold is recommended as 
the best remedy for mental depression. 

Authorities referred to : 

Gubler, Dr. Adolph. Commentaires du Codex Medicamentarius, Paris, 1868, p. 506. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Berlin, 1870, p. 310. 

Martini, Dr. Ludwig. Schmidfs Jahrbucher der gesammten Jfedicin, etc, vol. cxlvi, 
p. 263. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere 3/ediccde, huitieme edi- 
tion, vol. i, p. 388. 

Argentum. — Silver. Argent, Fr. ; Silber, Ger. 
. Argenti Oxidum. — Oxide of silver. An olive-brown powder, very 
slightly soluble in water. Dose, gr. ss — grs. ij, in pill. 

Argenti Mtras. — Nitrate of silver. A heavy, colorless, anhydrous 
salt, wholly soluble in distilled water, and crystallizing in shining, 
rhombic plates. Dose, gr. i — gr. ss, in pill, or in solution. 

Argenti JVitras Fusus. — Fused nitrate of silver. In cylindrical 
pieces. Is only used for topical applications. 

Argenti JVitras Dilutus. — Diluted (mitigated) nitrate of silver. 
Nitrate of silver, 50 parts ; nitrate of potassa, 50 parts. Formed in 
pencils or cones. 

Argenti Cyanidum. — Cyanide of silver. Is a white powder, insol- 
uble in water. Dose, gr. -fa — gr. fa, in pill-form. 

Argenti Iodidum. — Iodide of silver. An amorphous powder, yel- 
lowish in color, without taste, and insoluble in water or acohol. Dose, 

gr-.To— S r -i- 

Antagonists and Incompatibles. — The soluble chlorides and all 



282 AGENTS INCREASING WASTE. 

substances containing them are incompatible with the nitrate of silver ; 
hence most of the natural waters decompose it, because they contain 
more or less common salt. An insoluble chloride of silver is the result 
of the decomposition. The following mineral acids and their salts 
are chemically incompatible : Sulphuric, muriatic, tartaric, and sul- 
phurous. Alkalies and their carbonates, astringent infusions, and 
lime-water are incompatible. In cases of poisoning by nitrate of 
silver, common salt is the appropriate antidote. This should be 
given in solution very freely, to act as an emetic as well as chemical 
antidote. 

Therapeutically the salts of silver are antagonized by all those 
agents which promote constructive metamorphosis. 

Synergists. — All agents promoting waste, as mercury, iodides, etc., 
favor the action, therapeutically, of nitrate of silver. 

Physiological Actions. — Nitrate of silver acts chemically on the 
tissue to which it is applied. It combines with the albumen, and ex- 
cites a superficial inflammation, producing in some subjects vesication, 
in all a whitish eschar. It is, therefore, an escharotic, but of very 
limited activity. The white eschar produced by it, subsequently — 
under the influence of light — becomes brownish-black. 

Nitrate of silver has a strong metallic, styptic taste. A strong solu- 
tion, brushed over the mucous membrane, whitens it. In the stomach, 
the salts of silver produce a sense of warmth at the epigastrium, and, 
in large (toxic) doses, excite a violent gastro-enteritis. Meeting in the 
stomach soluble chlorides, undoubtedly the insoluble chloride of silver 
is formed, but a portion of the salt, probably, at once enters into com- 
bination with albumen and peptones. That the action of nitrate of 
silver, when swallowed, is not that of the chloride, has been experi- 
mentally shown ; hence the conversion of the nitrate salt into chloride 
does not suffice to explain the effects which ensue. Increased secre- 
tion from the intestinal glandular apparatus is produced by the silver 
salts, and the alvine dejections are softer and more frequent. Long- 
continued use of these agents will cause gastro-intestinal catarrh. 

The salts of silver most probably enter the blood as albuminates 
and peptonates. They effect very important changes in the blood, 
which becomes darker and more fluid, the red corpuscles paler and 
altered in outline, the haemoglobin converted into hsematin. A slight 
lowering of the temperature is a result of these changes in the com- 
position of the blood. Various tissues of the body undergo patho- 
logical alterations. The epithelium of the intestinal mucous membrane, 
of the kidneys and liver, becomes swollen and cloudy, and sometimes 
fatty. The amount of bile is increased, and albumen frequently ap- 
pears in the urine. The nutrition of the body is impaired and a pro- 
gressive diminution in weight and strength takes place. The venous 
system is found in a state of stasis ; transudations take place, the 



SILVER. 283 

action of the heart is rapid and irregular, and the respiration is embar- 
rassed. 

The nervous system participates in the general impairment of 
structure ; tetanic convulsions, paralysis, and insensibility, ensue. The 
paralysis is not due to alterations in the muscular system — for the 
muscles preserve their irritability — but is centric in origin. It is true 
the muscles, in poisoning by silver, become granular and their striae 
obliterated, but their contractility is not destroyed. 

Only a minute part of the silver administered is eliminated by the 
kidneys ; most of it escapes by the liver and the intestinal glands ; but 
a portion remains permanently deposited in the tissues if its adminis- 
tration has been protracted. Rarely is it safe to continue the use of 
the preparations of silver longer than six weeks, and occasional purga- 
tives should be given to promote elimination. An olive, slate-colored, 
or grayish-brown discoloration of the various tissues of the body results 
from a deposition of silver. This is usually first seen at the margin 
of the teeth or on the inside of the lips and cheeks, and is an indica- 
tion that the system is becoming saturated. I find in Sieveking, " On 
Epilepsy," the following instructive instance of argyria : " The pa- 
tient, a man aged sixty, became epileptic in March, 1856, and was 
treated with nitrate of silver almost from the commencement ; for 
nine months he took a daily pill containing six grains, so that, during 
that time, he swallowed nearly three and a half ounces. Toward the 
end of July the skin began to be discolored, but, in spite of gastric 
symptoms, the remedy was persevered in. In 1857 haemateinesis and 
other symptoms of gastric ulceration supervened, while the severity 
of the epilepsy had abated, and, having in the mean time come to 
England, he was admitted to the German Hospital, where he soon 
died. The special interest attaching to the autopsy is connected with 
the extent to which the silver had been deposited in the tissues. The 
parts in the face which had exhibited the greatest intensity of dis- 
coloration, owing to their containing more blood, now presented a tint 
uniform with the rest. In the brain the choroid plexuses presented 
a uniform grayish-blue tint. The lungs were tuberculous and pneu- 
monic, the heart hypertrophic. The stomach contained a large quan- 
tity of acid, brown liquid streaked with blood, and at the upper part 
of the posterior wall was a large ulcer, at the base of which was an 
orifice blocked up by the adherent pancreas. The mucous membrane 
of the duodenum and jejunum was dotted over with many small black 
granules, most closely aggregated along the folds. In the ileum these 
spots became more and more scanty. . . . The spleen was small, its 
veins had an ashen hue, which was due to a finely-granular precipitate 
upon their coats. The liver was small, congested, and fatty ; the small 
branches of the vena portae and of the hepatic veins presented the 
same precipitate of silver throughout, but the capillaries were free from 



884 AGENTS INCREASING WASTE. 

it. Fine sections of the hepatic tissue showed numerous black dots, 
each of which occupied the center of an acinus, corresponding to the 
point of exit of a central vein, and the color was produced by a black 
margin surrounding the caliber of the artery. The largest argentine 
deposit was in the kidneys. . . . The pyramids all exhibited a dark- 
gray color, which was deepest, and all but black, near the papilla?. 
The tubules in these parts were entirely invested with a dense precipi- 
tate. . . . Parts of the skin taken from the temporal, axillary, and 
digital regions, were examined. Transverse sections showed a pale, 
purplish streak immediately underneath the rete Malpighii, following 
the undulations of the cutis. . . . The glandular epithelium uniformly 
presented fatty degeneration." 

A persistent and long-continued use of the iodide of potassium and 
of the hyposulphite of soda has, in a few fortunate instances, caused 
the absorption and excretion of the silver deposits. The action of these 
systemic remedies for the discoloration may be aided by baths of the 
hyposulphites and by the cautious use of lotions containing the cyanide 
of potassium, which possess a decided solvent power over the silver 
deposits. 

Theeapt. — The oxide and the nitrate of silver are extremely ser- 
viceable remedies in the so-called nervous dyspepsia, and in chronic 
gastric catarrh. They are indicated in the following state of things : 
Pain after taking food, lasting for an hour or more (gastralgia), the 
digestion, although slow, being good ; burning pain, with pyrosis, com- 
ing on after the completion of the stage of stomach digestion ; eructa- 
tions of food, with sour and acrid matters — the first being a gastralgia, 
and the other states being caused by gastric catarrh, and consequent 
fermentation of the starch, sugar, and fats. r> Argenti oxidi, grs. v ; 
ext. hyoscyami, grs. v. M. Ft. pil. no. x. Sig. : One three times a day 
before meals. In chronic gastric catarrh, Frerichs recommends the 
following formula : r> Argenti nitrat., grs. xv ; aq. destil., q. s. ; ext. 
belladonna?, grs. x ; ol. caryophylli, gtt. x ; rad. gentian pulv., ext. 
gentianse, aa q. s. ut ft. pil. no. lx. Sig. : One pill three times a day. 
When there is much pain present, Wilson Fox highly commends the 
combination of nitrate of silver and opium in chronic gastric catarrh, 
but, as constipation so frequently attends this state, belladonna or 
hyoscyamus is usually to be preferred. Notwithstanding the strong 
opinion which Brinton has given adversely to the use of the salts of 
silver in ulcer of the stomach, the author agrees with Fox that these 
agents are, in this affection, next in value to bismuth. The oxide, or 
the nitrate, may be given in pill-form, as above, or the nitrate in solu- 
tion. In these stomach-affections, as a rule, the oxide of silver — being 
free from the causticity of the nitrate — is preferable. 

In jaundice dependent on catarrh of the biliary ducts, especially 
when there are present considerable pain and stomach-disorder, the 



SILVER. 285 

salts of silver not only give relief to some of the more distressing 
symptoms, but assist materially in restoring the functional activity of 
the liver. As respects these hepatic disorders, silver has an action simi- 
lar to arsenic, manganese, mercury, and some other mineral remedies. 

Frequently nitrate of silver is remarkably beneficial in cholera in- 
fantum, after the acuter symptoms have subsided. The following is 
an excellent formula for a child a year old : 1^ Argent i nitrat., gr. j ; 
acid, nitric, dil., TTt viij ; tinct. opii deod., ill, viij ; mucil. acacia?, § ss ; 
syrup, simplicis, § ss ; aquse cinnamomi, f j. M. Sig. : A teaspoonful 
every three, four, or six hours. The nitrate of silver is also an efficient 
remedy in that form of diarrhoea in children in which the stools are 
white, pasty, and offensive, and the urine is high-colored and acrid. In 
dysentery, both of children and adults, after the acute symptoms have 
ceased, and in chronic dysentery, the nitrate of silver is a most efficient 
remedy. In some epidemics of acute dysentery, when the constitutional 
condition is one of depression, it is equally effective. In these mala- 
dies it is better to prescribe the nitrate in pill-form (gr. \ — gr. j) com- 
bined with opium. With the stomach administration of the nitrate 
may be conjoined its local application to the rectal mucous membrane, 
and even in favorable instances to the descending colon. In using 
nitrate of silver by enema, the application, to be effective, should be 
made through a flexible tube passed cautiously to the sigmoid flexure 
or beyond. The bowel, previous to the introduction of the silver solu- 
tion, should be as thoroughly washed out as possible by tepid water. 
From ten to twenty grains of the nitrate of silver, to a jrint of water, 
is a suitable proportion for an enema. 

Obstinate dysenteric discharges, either alone or mixed with healthy- 
formed faeces, are not unfrequently caused by an ulcer of the rectum. 
The most effective treatment for such an ulcer consists in the applica- 
tion to it, through a suitable speculum, of the solid stick of nitrate of 
silver. 

The author's experience justifies him in asserting that the most 
effective remedy for the diarrhoea of phthisis is nitrate of silver com- 
bined with opium. When the diarrhoea of typhoid fever resists bis- 
muth, Hope's mixture, and laudanum enemata, a satisfactory result 
may often be obtained by nitrate of silver, as follows : £> Argenti 
nitrat., grs. iij; pulv. opii, pulv. ipecac, aa grs. vj. M. Ft. pil. no. xij. 
Sig. : One every four or six hours. The nitrate of silver is one of the 
numerous remedies which have been used in the treatment of cholera. 

Formerly nitrate of silver was much employed in the treatment of 
epilepsy, but it has justly fallen into disuse, for, besides the danger of 
tinting the skin, it is not as effective as much less objectionable reme- 
dies. Iodide of silver has proved very useful in the treatment of 
whooping-cough, in the hands of Dr. Bell, of Glasgow. He gives one 
^ghth of a grain. Since proposed by Wunclerlich, this agent has been 



-2S6 AGENTS INCREASING WASTE. 

fairly tested in the treatment of posterior spinal sclerosis (progressive 
locomotor ataxia), and seems to have some influence in retarding the 
progress of the disease. 

Local Uses. — Nitrate of silver is largely used as an external appli- 
cation. A case has recently been reported in which argyriasis was 
produced by the free application of this salt to the fauces, hence some 
care should be exercised in applying it to the mucous membranes. For 
external use, the cylinder and solutions of various strengths are em- 
ployed. The " mitigated " stick is used chiefly by ophthalmologists. 
The most satisfactory solution for local application to the skin is ob- 
tained by dissolving the salt in nitrous ether (gr. v — 3 j — f j of ether). 
This solution acts more energetically than the aqueous solution, and 
will readily vesicate. 

Solutions of nitrate of silver are much less frequently applied than 
formerly to inflamed tonsils, diphtheritic affections of fauces, acute 
laryngeal troubles, oedema of the glottis, etc. In the incipiency of 
tonsillitis, a strong solution (3j — 3 j — § j) may sometimes avert the 
attack, but if the inflammation be well established the irritant action 
of the caustic increases the morbid process. The most enlightened 
modern authorities (Oertel) condemn the use of caustics in diphtheria ; 
forcible detachment of the exudation only increases the chances of 
systemic infection, and injury done to the surrounding healthy mu- 
cous membrane invites the extension of the false membrane. A sufli- 
cient quantity of silver solution, to be effective, can not be applied to 
the larynx, nor even to the aryteno-epiglottidean folds, without the 
aid of the mirror, and this manipulation is hardly available when a 
state of acute inflammation exists. Follicular pharyngitis is one of 
the affections which can be successfully treated by systematic local 
applications of silver solution. Catarrh and ulceration of the poste- 
rior nares may be cured by persistent use of the same remedy, the 
application being made by a suitable sponge probang, or brush, passed 
behind the veil of the palate. The appropriate strength for these pur- 
poses will depend, in part, on habit (grs. v — 3j — 3 j). Very weak 
solution of nitrate of silver (gr. j — | j) is sometimes used by the 
spray-douche (glass tube) in chronic inflammation of the pharynx, 
larynx, and trachea. Besides the ineffectiveness of this method, it is 
objectionable because the silver spray stains the face and clothing of 
the patient, unless a shield is very carefully used. To ulcers of the 
to?isils, tongue, syphilitic and otherwise, the solid nitrate is often used. 
It is a very painful application, and possesses but slight, if any, advan- 
tages over carbolic acid, which is anaesthetic after the first contact. 

A strong solution of nitrate of silver, especially in nitrous ether, is 
a most efficient application to check inflammation in superficial parts, 
e. g., boils, felon (paronychia), thecal abscess, orchitis, synovitis, etc. 
It is essential to the success of this treatment that the application be 



SILVER. 287 

made early. According to the method of Mr. Furneaux Jordan, it is 
better to make these applications to the adjacent "vascular territory," 
than to the inflamed part directly. To illustrate : In the case of orchitis, 
instead of painting the silver solution over the testicle, it is better to 
apply it along the groin and inner face of the thigh, over the course 
of the great vessels. 

Mr. Higginbottom, who is the author of this method of treatment, 
says that " we have no therapeutic agent so safe, powerful, or effica- 
cious, as the nitrate of silver in subduing external inflammation when 
properly applied. It has been invariably successful in my hands for 
nearly the last forty years." Such unstinted praise from so eminent 
an authority deserves our most respectful consideration. As the 
proper application of the remedy is so important, it were better to 
follow literally the method of Mr. Higginbottom : " The affected part 
should be well washed with soap and water, then with water alone, to 
remove every particle of soap, as the soap would decompose the 
nitrate of silver ; then to be wiped dry with a soft towel. The con- 
centrated solution of four scruples of the nitrate of silver to four 
drachms of distilled water is then to be applied two or three times on 
the inflamed surface and beyond it, on the healthy skin, to the extent 
of two or three inches. The solution may be applied with a small 
piece of clean linen, attached to the end of a short stick ; the linen to 
be renewed at each subsequent application. ... In about twelve 
hours it will be seen whether the solution has been well applied. If 
any inflamed part be unaffected, the solution must be immediately re- 
applied." 

The method of Mr. Higginbottom is extremely effective in trau- 
matic erysipelas. The common facicd erysipelas rarely requires any- 
thing but the simplest application. The concentrated solution of ni- 
trate of silver should be thoroughly applied to malignant carbuncle of 
the lip, and to the adjacent healthy skin for a short distance. The pit- 
ting of small-pox maybe prevented by rupturing each pustule and in- 
serting into it a sharply -pointed pencil of the nitrate of silver. Ac- 
cording to Mr. Higginbottom, the same result may be accomplished, 
and with greatly less labor, by applying his solution in the manner 
above indicated. 

The solution of nitrate of silver in nitric ether (3ij — § j) is recom- 
mended by Fox in the chronic forms of erythema, eczema, psoriasis, and 
ringworms. Indolent ulcers, discharging sores with flabby granula- 
tions, are improved in character and made to heal by application of 
Higginbottom's concentrated solution, or of solid caustic. 

Ulceration of the cervix uteri, endo-cervieitis, granular cervicitis, 
endo-metritis, are effectively treated by nitrate of silver applications. 
The solid caustic may be quickly brushed over the mucous membrane, 
or a concentrated solution may be applied with a suitable " applicator." 



288 AGENTS INCREASING WASTE. 

There is no doubt that solid caustic may be applied with safety in 
chronic cases to the interior of the uterine cavity, after preliminary 
dilatation of the cervical canal. This is a most effective treatment, 
but injury is often done by over-stimulation and too prolonged con^ 
tact of the caustic. Induration of the cervix and narrowing of the 
cervical canal are sometimes produced by injudicious use of the solid 
caustic. That troublesome affection, pruritus of the vulva, may often 
be removed, even when due to pregnancy, by washing the neck, and 
the cervical canal so far as it is accessible, with a strong solution of 
the nitrate of silver (3j — § j). When the pruritus is due to a vesic- 
ular eruption on the genitals, the application should be made to the 
affected part. Gonorrhoea (vaginal) of the female is most quickly 
removed by applying through the speculum, and to every part of the 
canal, a concentrated solution of silver nitrate ( 3 j — 3 j). In the male, 
gonorrhoea, at its first appearance, may sometimes be aborted by a 
strong injection ( 3 j — 1 j), but unfortunately the period is usually 
past when this violent practice may be advised. Weak solutions (gr. 
j — grs. v — | j) are, as a rule, more efficient, as they are unquestionably 
safer. Cauterization of the prostatic part of the urethra was at one 
time vulgarized in the treatment of spermatorrhoea by the influence of 
Lallemand, but this dangerous practice is rarely necessary. The au- 
thor coincides with Mr. Furneaux Jordan in the expression of the be- 
lief that a vesicating solution of nitrate of silver applied to the peri- 
nseum is as generally useful and, of course, entirely without danger. 

Solutions of nitrate of silver are much used in ophthalmic and au- 
ral surgery. To granular lids, a strong solution (3j — § j) * s a P" 
plied ; to acute conjunctivitis, a weak solution (gr. j — grs. iv — § j ); 
but generally ophthalmologists prefer the zinc and copper salts in the 
treatment of tiiese affections. The incautious use of silver salts, when 
there are corneal ulcers, may result in unsightly deposits and opaci- 
ties. Otorrhoea, eczema of the external auditory meatus, and chronic 
inflammation of the external ear, may be cured by silver solutions 
properly applied. A commencing furuncle of the external canal may 
sometimes be aborted by application of Mr. Higginbottom's solution. 

The stains made by nitrate of silver on fabrics or on the hands 
may be removed as follows : Moisten the spots and drop upon them 
a few drops of tincture of iodine, and wash with a solution of hyposul- 
phite of soda ( 3 ss — f j). These stains may also be removed by 
washing them with the following solution : Cyanide of potassium, 
3 ijss ; iodine, grs. xv ; water, 3 iij. 

Besides the above-mentioned external applications of nitrate of sil- 
ver, this salt is also used according to the method of Luton, entitled 
" parenchymatous substitution." This consists in injecting, with a 
hypodermatic syringe, a few drops of a concentrated solution into the 
parenchyma of organs — an irritant injection. Cystic tumors (wens), 



COPPER. 289 

small fatty tumors, abscesses, and hydrocele, may be cured by inject- 
ing five to ten drops of a strong solution (3j — 3 ij). In the case of 
cysts and hydrocele, the contents may be allowed to escape through 
the needle, and then the irritant solution be injected. More or less 
active inflammation follows, and the sac, after a variable stage of sup- 
puration, becomes entirely obliterated. 

Old and intractable cases of sciatica that resist other means, includ- 
ing hypodermatic injection of anodynes, are sometimes permanently 
relieved by injecting deeply into the neighborhood of the affected 
nerve ten to twenty drops of a solution of nitrate of silver. Suppura- 
tion usually follows, and the local inflammatory process terminates the 
previously-existing nerve-lesion (parenchymatous substitution). 

Authorities referred to : 

Bartholow, Dr. Roberts. Manual of Hypodermatic Medication, fourth edition, arti- 
cle, Irritant Injections. 

Bogolowsky, Dr. Virchow's Archiv fur pathologische Anatomic, vol. xlvi, 1869, 
p. 409. 

Fox, Dr. Tilbury. On Diseases of the Skin, second edition, 1873. 

Fox, Dr. Wilson. On Diseases of the Stomach, revised edition, London and New 
York, 1872, pp. 93, 142, 179. 

Higginbottom, John, F. R. S. The Practitioner, vol. ii, p. 34. 

Jordan, Furneaux. The Practitioner, vol. ii, p. 74. 

Reynolds, Dr. Russell. On Epilepsy, London, 1861, p. 333. 

Sieveking, Dr. Edward H. On Epilepsy, second edition, London, 1861. 

Scattergood, Br. Thomas. British Medical Journal, May 20, 1871. 

Cuprum. — Copper. Cuivre, Fr. ; Kupfer, Ger. 

Cupri Acetas. — Acetate of copper. Deep-green, prismatic crystals, 
yielding a bright-green powder, efflorescent on exposure to air, odor- 
less, having a nauseating, metallic taste and an acid reaction. Soluble 
in 15 parts of water, and in 135 parts of alcohol at 60° Fahr. Dose, 

g r - -h— g r - I- 

Cupri Sulphas. — Sulphate of copper. Blue vitriol. In blue crys- 
tals, slightly efflorescent in the air, and soluble in 2*6 water at 60° 
Fahr. Ammonia throws down from the solution a precipitate, which 
is wholly dissolved when the alkali is added in excess. Dose, gr. 
I— gr. ss. 

Cuprum Ammoniatum, — Ammoniated copper. (Not official.) A 
deep, azure-blue powder, having an ammoniacal odor, and a styptic, 
metallic taste. It is soluble in water. Dose, gr. -J- — gr. j. 

Antagonists and Incompatibles. — Alkalies and their carbonates, 
lime-water, mineral salts (except the sulphates), iodides, and most 
astringent vegetables, are chemically incompatible with the salts of 
copper. In cases of poisoning, white of eggs and milk should be given 
freely, but evacuation of the contents of the stomach is necessary, for 
the albuminate of copper is not devoid of toxic power. The most 
20 



290 AGENTS INCREASING WASTE. 

effective chemical antidote is said to be the ferrocyanide of potassium, 
forming the insoluble ferrocyanide of copper. Magnesia has also been 
proposed, but it should not be relied on to the exclusion of albumen 
and ferrocyanide of potassium, nor should any antidote be used with- 
out evacuating the stomach contents by emetics or the stomach-pump. 

Synergists. — The salts of lead, tin, zinc, mercury, silver, gold, 
favor the therapeutic action of the copper-salts. All of these agents 
agree in this : they promote waste, and affect the functions of the nerv- 
ous system secondarily. All unfavorable hygienic conditions, which 
depress the functions of the body, increase the activity of the copper- 
salts. 

Physiological Actions. — The salts of copper have a styptic, me- 
tallic taste. When a poisonous dose of a copper-salt has been taken 
the following symptoms, referable to the digestive organs, appear : A 
strong metallic taste, burning and constriction of the throat, increased 
flow of saliva, burning pain at the epigastrium, with griping and colic- 
pain of the intestines, nausea and vomiting. The vomited matters 
have usually a bluish or greenish color, and the intestinal evacuations, 
which begin in a few minutes after the poison has been swallowed, are 
dark-greenish and frequently bloody. These are the symptoms pro- 
duced by the irritant poisons, and have no special characters, except, 
it may be, the color of the evacuations. The salts of copper, being 
diffusible substances, quickly enter the blood, and the systemic symp- 
toms which follow are referable to the nervous system and the organs 
of excretion. In the blood, as is the case with the other metallic poi- 
sons, copper probably exists in the form of an albuminate in close re- 
lation to the red blood-globules. The breathing becomes short, hur- 
ried, and labored ; the pulse small, quick, and weak ; the skin cold 
and perspiring, and restlessness, headache, trembling, cramps, vertigo, 
and stupor, are followed by convulsions (clonic or tetanic), paralysis, 
and insensibility. 

Inhalation of cupreous fumes, as in certain occupations in the arts, 
the slow introduction of small quantities, as occurs sometimes from 
cooking acid fruits in copper vessels, or the prolonged medicinal ad- 
ministration of moderate doses of a copper-salt, will produce the symp- 
toms of chronic or slow poisoning. When inhaled, the symptoms first 
observed are those of bronchial irritation and bronchial catarrh (Hirt). 
Internally administered, a gastro-intestinal catarrh is produced, epigas- 
tric pain is experienced, nausea, vomiting, colic, tenesmus, and dysen- 
teric discharges, and complete anorexia occur. The loss of appetite, 
and the interference with digestion, as well as the injury done to the 
red blood-globules, impair the strength and increase the waste of the 
tissues. A purplish line along the margin of the gum has been ob- 
served, salivation and ulceration of the gums not unfrequently occur, 
and occasionally jaundice is present as one of the symptoms. As re- 



COPPER. 291 

gards the nervous system, headache, muscular trembling, paresis of the 
limbs, and sometimes paralysis, altered sensations, defects of co-ordi- 
nation, impaired mind, result. These nervous symptoms, with bron- 
chial and gastro-intestinal catarrh, are usually grouped together in the 
case of chronic cupreous poisoning in artisans. 

Copper is eliminated by the liver, intestinal canal, salivary glands, 
and kidneys. As is the case with the other metallic poisons, copper 
tends to accumulate in the liver. 

Therapy. — The sulphate of copper is one of the remedies some- 
times effective in the vomiting of pregnancy. For this purpose not 
more than one twentieth of a grain, three times a day, is admissible. 
B Cupri sulphat., grs. ij ; aquae destil., § ss. M. Sig.: Six drops a 
dose. 

As sulphate of copper is a very prompt and effective emetic, it is 
frequently resorted to in cases of narcotic poisoning. r£ Cupri sul- 
phat., grs. vj ; aquae destil., J ij. M. Sig. : A tablespoonful every fif- 
teen minutes until vomiting e?isue. It may be used under the same 
circumstances, but is by no means so desirable an emetic, in croup, as 
subsulphate of mercury. Minute doses of sulphate of copper render 
excellent service in gastro-intestinal catarrh, especially when the bow- 
els are relaxed. I£ Cupri sulphat., gr. j ; ext. nucis vom., grs. iv. M. 
Ft. pil. no. xvj. Sig. : One three times a day before meals. When the 
food taken gives rise to colic, which is quickly followed by the incli- 
nation to stool, there should be combined with the above prescription 
one grain of morphine sulphate. When the constipation coexists 
with intestinal catarrh, the following prescription is useful : I£ Cupri 
sulphat., gr. j ; ext. physostigmae, ext. belladonnas, ext. nucis vom., aa 
grs. iv. M. Ft. pil. no. xvj. Sig. : One pill, three times a day, be- 
fore meals. 

The sulphate of copper is a most useful remedy in acute dysentery. 
1^ Cupri sulph., gr. ss ; magnesias sulph., § j ; acid, sulph. dil., 3 j ; 
aquae, § iv. M. Sig. : A tablespoonful every four hours. After the 
acuter symptoms have subsided, the sulphate of copper may be given 
with morphine and opium. Of all the metallic astringents employed 
for this purpose, sulphate of copper is the most effective in chronic 
diarrhoea and chronic dysentery, t^ Cupri sulphat., grs. j ; morphinse 
sulph., gr. j; quininae sulph., grs. xxiv. M. Ft. pil. no. xij. Sig.: One 
pill three times a day. Sulphate of copper is indicated when there are 
present colic-pains, tenesmus, and the stools, partly feculent, contain 
mucus streaked with blood. When tolerance is established, the quan- 
tity of copper in the above formulae may be increased slowly to one 
fourth of a grain. Rarely can more than one twelfth of a grain be 
given to an adult unaccustomed to its use, without causing very un- 
pleasant nausea and depression. 

The dysentery and cholera infantum of children, and the chronic 



292 AGENTS INCREASING WASTE. 

enter o-colit is which sometimes succeeds to measles, are often remark- 
ably benefited by minute doses of sulphate of copper. I£ Cupri sul- 
phat., gr. j ; tinct. opii deodor., gtt. viij ; aquae destil., § iv. M. Sig. : 
A teaspoonful every two, three, or four hours, for a child from one to 
two years of age. 

The sulphate of copper is a useful palliative astringent in the diar- 
rhoea of phthisis. It should be combined with opium. 

Kissel regards the salts of copper as curative in pneumonia, and 
the preparation which he prefers is the tincture of the acetate (Phar. 
Ger.). The mortality under this treatment was only 4 - 3 per cent. Am- 
moniated copper has been used recently with remarkable success in 
the treatment of facial neuralgia. It must be pushed (Fereol). 

The salts of copper, especially the ouprum ammoniatum, are among 
the numerous remedies employed in the treatment of ep/depsy, chorea, 
and hysteria. Successful results have, it is true, been obtained by the 
use of these remedies, but at the present time they are rarely employed. 

Exteexal Uses. — The salts of copper do not act very energeti- 
cally on the unbroken integument. Applied to wounds they are as- 
tringent — that is, they combine with albumen, contract the tissues, 
and coagulate the blood. A crystal of sulphate of copper may be used 
to arrest bleeding from small icounds, e. g., from leech-bites. Indolent 
tdcers with flabby granulations can be stimulated to a renewed and 
more healthy activity by touching the affected surface with a crystal 
of sulphate of copper, or by frequent application of a solution (grs. ij 
— grs. x — J j). The following is an excellent injection in gonorrhoea 
after the acute stage : 3 Cupri sulph., grs. iv ; niorphinae sulph., grs. 
viij ; liq. plumbi subacetat., 3 j ; aquae rosae, J iv. M. Sig. : As an 
injection. In that troublesome affection, granular lids, the sulphate 
of copper may be rubbed over the everted lid once a day with advan- 
tage. The application gives great pain, and is immediately followed 
by intense hyperemia, which, however, subsides in a few hours, leav- 
ing the conjunctiva in much better condition than before. 

In scabies, a solution of sulphate of copper ( 3 j — Oj) has been used 
with great success, the lotion being applied after the crusts have been 
thoroughly removed with soap and water. An ointment of acetate of 
copper (grs. x — § j) is a very effective application in herpes circinatus 
(ringworm). The following formula has been recommended in menta- 
gra : IJ Cupri sulph., 3 j ; zinci sulph., 3 ss ; aquae laur.-cerasi, 3 jss ; 
aquae destil. ad § xvj. M. Sig. : Lotion. The acetate and carbonate 
of copper are very effective remedies in tinea sycosis. r> Cupri carb., 
3 ij ; adipis, § j. M. 

Authorities referred to : 

Hirt, Dr. Ludwig. Die KranJcheiten der Arbeiter, erste Abtheilung, p. 79, et seg. x 
Breslau, 1871. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, Berlin, 1S74, p. 209. 



LEAD. 293 

Gubler, Prof. Adolph. Commentaires Therapeutiques du Codex Medicamentarius^ 
Paris, 1868, p. 435. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittcllehre, Berlin, 1870, p. 291. 

Tardieu, Ambroise. Dictionnaire d 'Hygiene Publique et de Salubrite, deux, edition. 
Paris, 1862, vol. i, article Cuivre. 

Taylor, Dr. A. S. On Poisons, p. 458, et seq. 

Plumbum. — Lead. JPlomb, Fr.; JBlei, Ger. 

Plumbi Oxidum. — Oxide of lead. Litharge. In small yellowish 
or orange-colored scales, insoluble in water, but almost wholly soluble, 
with slight effervescence, in dilute nitric acid. The solution is affected 
by potassa, like that of carbonate of lead in the same acid. 

Emplastrum Plumbi. — Lead-plaster. Litharge and olive-oil. 

Plumbi Acetas. — Acetate of lead. Sugar of lead. In colorless 
crystals which effloresce on exposure to the air. It is dissolved by dis- 
tilled water, with a slight turbidness, which is removed by the addi- 
tion of vinegar. With this solution carbonate of sodium produces a 
white, iodide of potassium a yellow, and hydrosulphuric acid a black 
precipitate. Upon the addition of sulphuric acid, vapor is evolved, 
having the smell of vinegar. Dose, gr. ss — grs. v. 

Liquor Plumbi Subacetatis. — Solution of subacetate of lead. A 
colorless liquid of the specific gravity of 1*267. It is decomposed by 
exposure to the air, carbonate of lead being formed. When added to 
a solution of gum it occasions a dense white precipitate. 

Liquor Plumbi Subacetatis JDilutus. — Diluted solution of subace- 
tate of lead. (Solution of subacetate, 3 iij ; distilled water, Oj.) 

Ceratum Plumbi Subacetatis. — Cerate of subacetate of lead. So- 
lution of subacetate of lead, 20 parts ; camphor cerate, 80 parts. 

Plumbi Carbonas. — Carbonate of lead. A white substance in 
powder or pulverulent masses, insoluble in water, but soluble, with ef- 
fervescence, in dilute nitric acid. Potassa added to the solution pro- 
duces a white precipitate, which is wholly dissolved by an excess of 
the alkali. Heat renders it yellow, and, with the aid of charcoal, re- 
duces it to the metallic state. 

Unguentum Plumbi Carbonatis. — Ointment of carbonate of lead. 
(Carbonate of lead, 10 parts ; benzoinated lard, 90 parts.) 

Plumbi JVitras. — Nitrate of lead. In white, nearly opaque, octa- 
hedral crystals, permanent in the air, and of a sweet astringent taste. 
It is soluble in seven and a half parts of cold water, and in alcohol. Its 
solution is precipitated black by hydrosulphate of ammonium, white by 
ferrocyanide of potassium, and yellow by iodide of potassium. 

Plumbi Lodidum. — Iodide of lead. A bright-yellow, heavy, in- 
odorous powder, fusible and volatilizable by heat, and soluble in twelve 
hundred and thirty-five parts of cold, and one hundred and ninety- 
four parts of boiling water. A hot saturated solution, on cooling, de- 
posits the salt in brilliant, golden scales. 



294: AGENTS INCREASING WASTE. 

Unguentum Plumb i Iodldi. — Ointment of iodide of lead. (Iodide 
of lead, 10 parts ; benzoinated lard, 90 parts.) 

Antagonists and Incompatibles. — Natural waters containing 
lime, sulphates, carbonates, carbonic acid, mineral acids and mineral 
salts, vegetable acids, alkalies, iodide of potassium, the vegetable 
astringents in general, albuminous solutions, and the preparations of 
opium, are incompatible. In cases of poisoning by acetate of lead, 
the proper antidotes are the sulphates of soda or magnesia, phosphate 
of soda, milk, and albuminous solutions. Emetics and the stomach- 
pump should be used. 

Synergists. — Cold, digitalis, ergot, veratrum viride, and agents 
acting similarly, favor the influence of acetate of lead over the circu- 
latory system. Copper, mercury, antimony, and remedies promoting 
waste, increase the depressing effects of lead on the nutrition of the 
body. 

Physiological Actions. — The acetate is astringent ; that is, it 
combines with albumen to form compounds, for the most part insolu- 
ble in water and in acids. All the salts of lead are more or less toxic. 
As the acetate, which is most frequently the preparation taken, has a 
sweetish taste, mistakes not unfrequently happen ; but the after-taste 
is decidedly astringent and slightly metallic. As the combination of 
the salts of lead with albumen takes place on contact, this action en- 
sues in the mouth in part, and is completed in the stomach. Any 
part of the lead reaching the intestinal canal must be converted into 
the insoluble sulphide. A very large quantity of the acetate of lead 
is required to produce a fatal effect ; not less than an ounce. When 
swallowed in this quantity and retained, it produces intense gastric 
irritation, sometimes cholerif orm symptoms, numbness, paralysis, coma, 
collapse. Owing to the fact that so large a quantity of acetate of 
lead will be rejected by vomiting, cases of acute poisoning rarely 
terminate fatally, and are infrequent. On the other hand, chronic poi- 
soning by lead is very common, owing to the use of cosmetics and 
hair-dyes containing lead, the use of food preserved in tin cans sol- 
dered with lead, and to the contamination of drinking-water. Very 
rarely is the acetate of lead so persistently used in medical practice as 
to produce toxic symptoms. 

When lead is slowly introduced into the organism in small doses, 
the first symptoms usually observed are loss of appetite, failure of 
strength, more or less wasting, paleness of the face and of the integu- 
ment generally, and constipation. The joints become the seat of 
rheumatoid pain ; there is dry colic, the pain of which is assuaged by 
pressure ; and the muscles of the abdominal parietes are also seized 
with neuralgia. At the same time the liver diminishes in size, the 
abdominal fat disappears, the intestines are contracted, the belly is 
drawn in toward the spinal column. Coincidently with the contrac- 



LEAD. 295 

tion of the liver, the skin assumes an icteroid hue, the conjunctiva? be- 
come yellow, and the urine is tinged with the biliary coloring matters. 
At this time may be observed the so-called " blue line " along the 
margin of the incisor teeth — a slate-colored line, probably due to a 
deposition of the sulphide of lead, and found only, according to the 
author's experience, in those not accustomed to the use of a tooth- 
brush. The mucous membrane of the lips and mouth has often a blu- 
ish or slate-colored tint, and sometimes brownish pigment-deposits are 
seen on the lips near the teeth, and on the gums. Albuminuria may 
exist at this time, but it is commonly present further on in the history 
of these cases. Lead may cause that condition of hyperalbuminosis 
which eventuates in albuminous urine, but probably it in most cases 
hastens the development of changes in the kidneys already impending. 
As Garrod has conclusively shown, the use of lead, or its slow intro- 
duction through unknown channels, hinders the conversion of uric 
acid into urea, and favors the deposition of urate of soda about the 
joints : hence the arthritic pains which accompany the other symp- 
toms of chronic lead-poisoning, and the intimate relation of the pres- 
ence of lead in the organism and gouty attacks. 

The symptoms thus far sketched are chiefly those due to the influ- 
ence of the agent over the oxidation processes of the body in general. 
It is necessary now to consider the action of lead on the nervous sys- 
tem. Lead gastralgia is an early symptom, in part due to the fact 
that the metal acts directly on the nerves of the stomach, but it is also 
a symptom of the action of the poison on the central nervous system. 
Lead arthralgia, already referred to, is frequently an affection of the 
intra-muscular nerves, and has its seat more especially in the flexor 
muscles. The swelling of the joints and the joint-pains are doubtless 
due, as already explained, to the deposition of the urates in the joints 
themselves, but the term arthralgia is used to describe that form of 
pain about the joints produced by lead. Impaired sensibility to touch 
is also one of the phenomena of lead-poisoning. This lead-ancesthesia 
is found about the neck, chest, the forearms (their palmar face), hands, 
and fingers, and is symmetrically distributed on the two sides. An- 
aesthesia of the optic (amaurosis) is also a result of the direct action 
of lead, but dimness of vision and a sluggish pupil may also be due to 
the albuminuria which is so frequently present. Paralysis of the com- 
mon extensors of the fingers and of the supinators, while the power of 
the flexors and pronators is much less diminished, constitutes that 
very striking symptom of lead-poisoning, " the drop-wrist." When 
the arms are raised the hands drop forward and to the palmar face 
of the forearm, from an inability of the extensors to hold them up. 
Paralysis may invade the laryngeal muscles, producing aphonia. 
Sometimes the paralysis has the hemiplegic form, and, still more 
rarely, the paraplegic. At the beginning of the paralysis, the mus- 



296 AGENTS INCREASING WASTE. 

eular irritability is preserved, but it soon lessens, and is lost finally, 
so that the muscles cease to respond to the faradic current. For some 
time after the induction current fails to excite contraction, muscu- 
lar movements may be obtained by a slowly- interrupted galvanic 
current. 

Death may result from the saturnine cachexia, by the gradual fail- 
ure of nutrition, and by the extension, finally, of the muscular paraly- 
sis to the muscles of respiration. Death may occur much earlier, by 
the development of those symptoms to which has been applied the 
term lead-encephalopathy — a form of disease characterized by delirium 
and convulsions, ending in fatal coma. 

Lead is very fatal to the life of the foetus, and women the subjects 
of the saturnine cachexia abort early, or produce stillborn children. 

After death, lead is found in various organs of the body, and rela- 
tively in large amount in the brain. It is also largely deposited in the 
substance of the affected muscles and nerves, and the destruction of 
the Hallerian irritability, the disappearance of the striation and the 
granular condition of the nerves, are probably due to the direct action 
of the metal. Lead, also, like the other minerals, tends to accumulate 
in the liver ; much of it is probably eliminated by the intestinal glands 
and skin, and some passes out by the kidneys. 

The treatment of lead-poisoning is prophylactic and curative. 
Among the former are, personal cleanliness, frequent bathing, the use 
of sulphuric-acid lemonade, the habitual employment of milk in large 
quantity as a food, and the avoidance of All sources of contamination. 
Among the curative measures must be placed first, large doses of the 
iodide of potassium, purgative doses of Epsom salts, and sulphur-baths. 
The affected muscles should be early faradized to prevent atrophic 
changes. When they fail to respond to a faradic current, a slowly- 
interrupted galvanic current should be used, and after a time the fara- 
dic irritability may be recovered. 

Therapy. — Acetate of lead is one of the astringent remedies em- 
ployed to arrest hmmatemesis. It is more especially adapted to the 
vomiting of blood which accompanies gastric ulcer. This salt exercises 
a favorable influence over the course and progress of gastric ulcer ; it 
allays pain and local inflammation, and modifies the ulcerated surface. 
In chronic gastric catarrh with gastralgia and pyrosis, it has given 
great relief. Notwithstanding the chemical incompatibility, it may be 
advantageously combined with morphine in painful stomach-affections. 
The most frequent use of the acetate of lead in gastro-intestinal dis- 
orders is in the treatment of the various forms of diarrhoea. It is an 
excellent remedy in the summer diarrhoea of children. $. Plumbi 
acetat., grs. viij ; acid, acetic, gtts. vj ; tinct. opii deodor., gtts. iv ; 
aquse destil., % j. M. Sig. : A teaspoonful every two, three, or four 
hours for a child two years of age. In choleraic diarrhoea, acetate of 



LEAD. 297 

lead is one of the most useful astringents : ^ Plumbi acetat., grs. 
xxiv ; pulv. opii, grs. xij ; pulv. camphorae, 3 ss ; sacch. alb., q. s. Ft. 
pulv. no. xii. Sig. : One powder every hour or two. It is sometimes 
preferable to administer the acetate of lead in solution, when the for- 
mula above given for children may be used in corresponding dose for 
adults. Probably, the most generally successful remedy for the diar- 
rhoea of phthisis is a pill containing equal parts of acetate of lead and 
opium. The diarrhoea of typhoid may also be restrained by acetate 
of lead and opium ; but generally bismuth is more suitable than acetate 
of lead. In acute and chronic dysentery lead is often a useful astrin- 
gent. Enemata of lead and morphine (!£ Plumbi acetat., grs. iv ; 
morphinse acetat., gr. ss; aquae fervid., § j) allay the tenesmus of acute 
dysentery. Enemata of corresponding strength to age, of the same 
composition, are very useful in the cholera infantum of children. 

Although the salts of lead undergo important chemical changes in 
the intestinal canal, and are probably very much modified in composi- 
tion before they enter the blood, yet there is no doubt about their 
power to affect remote parts. The value of acetate of lead in various 
forms of hemorrhage has been attested by an immense clinical expe- 
rience. Thus, in hemoptysis, it is a most useful haemostatic. Careful 
observations on a case of severe and protracted pulmonary haemorrhage 
demonstrated that five grains of the acetate, every three hours, exer- 
cised a remarkable influence over the arterial tension and the action 
of the heart. Its effects are similar to those of digitalis : it slows the 
action but increases the power of the heart, while at the same time it 
elevates the tension of the arterioles. The astringent is, however, a 
dynamical and not a chemical action, doubtless. There is, therefore, 
a fitness in the prescription of Oppolzer for caseous pneumonia : Pjfc Inf. 
digitalis, § iv ; plumbi acetat., 3 j ; tinct. opii, 3 j. M. Sig. : A table- 
spoonful twice a day. A similar combination is serviceable in haemop- 
tysis: I> Plumbi acetat., 3ij ; pulv. digitalis, 3] ; pulv. opii, grs. x. 
M. Ft. pil. no. xx. Sig. : One every four hours. 

By virtue of its astringent action acetate of lead restrains secretion, 
and hence its utility in bronchorrhcea. It is also serviceable in humid 
asthma and whooping-cough. 

Formerly acetate of lead was used to quiet the action of the heart 
in hypertrophy, and to favor coagulation of the blood in the case of 
internal aneurism. It might often be usefully employed in these af- 
fections now. 

In prescribing the preparations of lead for internal use, the danger 
of producing plumbism should not be overlooked. When it is used 
for any considerable period, the gums should be frequently inspected, 
and on the slightest appearance of a blue line, or on the occurrence of 
constipation and abdominal pain, the remedy should be at once discon* 
tinued. 



298 AGENTS INCREASING WASTE. 

External Application of Lead Preparations. — The uses of 
lead preparations for external diseases are numerous and important. 
An excellent application to burns is white-lead paint — carbonate of 
lead and linseed-oil. This may be objectionable when the surface is 
very large, lest a dangerous amount of absorption take place, but for 
burns of small extent it is safe and gives great relief. The surface of 
the burn is thickly coated with the paint. Lead-lotion {liquor plumbi 
subacetatis dilutus) is a good application to eczema when there is much 
weeping. The following ointment has been recommended in this af- 
fection : fy Plumbi acetat., f ss ; camphor, pulv., grs. xv ; ol. amyg- 
dal.,|ij; cerae flavae, f j. M. Ft. cerat. An excellent formula for 
eczema, when there are great heat and redness, and profuse discharge, 
consists of liquor plumbi subacetatis, 5 j ; glycerinae, f ss ; and cherry- 
laurel water, 3 iijss. The following formula is recommended by Fox 
in eczema and lichen: I£ Acid, nitrici dil., 3 ss ; plumbi acetat., grs. v ; 
aquae, f vj. M. In erythema the carbonate of lead is used with advan- 
tage : ^ Plumbi carb., grs. iv ; glycerinae, 3 j ; cerat. simplicis, f j. M. 
In impetigo the following : Ifr Plumbi acetat., grs. xv ; acid, hydro- 
cyan, dil. , ttj, xx ; alcoholis, J ss ; aquae, 3 vss. M. 

Lead lotions are much used to cure muco-pundent and purident 
discharges from the ear, the vagina, and the urethra. They may be 
employed at any stage, and the existence of inflammation does not 
contraindicate their use. The following is a useful formula for gonor- 
rhea: ^ Liq. plumbi subacetat. dil., 3 iv ; zinci sulphat., grs. viij. M. 
Sig. : As an injection. A chemical change, of course, takes place, but 
clinical experience is in favor of the combination. 

The ointment of the iodide of lead is often a useful application to 
enlarged lymphatic glands and to enlarged spleen. It is also employed 
with benefit in cases of chronic eczema, porrigo, and psoriasis. 

A solution of the nitrate of lead in pure glycerin (grs. x — § j) is 
an effective application to fissured nipples. It need hardly be re- 
marked that the nipple should be well washed before the child is per- 
mitted to suck. Nitrate of lead in form of powder, dusted over the 
unhealthy granulations, gives great relief, and hastens the healing of 
onychia. 

Authorities referred to : 

Garrod, Dr. A. B. The Nature and Treatment of Gout, London, 1869. 

Gusserow, Prof. Dr. Archiv fur pathologische Anatomie, xxi, 443. 

Hermann, Dr. L. Lehrbuch der ezperimentellen Toxicologic, Bleisalze, p. 196, 
et seq. 

Hirt, Dr. Ludwig. Die Krankheiten der Arbeiter, p. 92, et seq. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, Blei-Praparate, p. 268, 
et seq. 

Rosen'stein, Prof. Dr. Archiv fur pathologische Anatomie, xxxix, 1 und 174. 

Schmidt's Jahrbucher der gesammten Medicin, vol. cxliv, p. 279. Mittheilungen 
ueber Bleivergiftung, von L. Pappenbeim ; E. Clapton ; A. Bobiene ; E. Buehner ; Alois 






ZINC. 299 

Gruber; Stamm ; Bucquoy; A. Gubler ; Nicaise; E. Meyer; Murchison; Paleari ; Pan- 
thiel. 

Second Annual Report of the State Board of Health of Massachusetts, 1871, p. 21. 

Tardieu, Ambroise. Diciionnaire d'Hygiene publique et de Salubrite, deux, edition, 
tome troisieme, p. 334. 

Zincum. — Zinc. Zinc, Fr. ; Zinh, Ger. 

Zinci Oxidum. — Oxide of zinc. A yellowish- white powder, in- 
soluble in water, but soluble in dilute sulphuric and muriatic acids 
without effervescence. The solutions, when neutral, yield white pre- 
cipitates with ferrocyanide of potassium and hydrosulphate of ammo- 
nium. Dose, gr. ss — grs. v. 

Zinci Carbonas Precipitatus. — Precipitated carbonate of zinc. A 
light, white powder, odorless and tasteless, and insoluble in water or 
alcohol. 

Ceratum Zinci Carbonatis. — Cerate of carbonate of zinc. (Not 
official.) (Carbonate, § ij ; ointment, % x.) 

Zinci Sulphas. — Sulphate of zinc. In colorless crystals, which ef- 
floresce on exposure to air. It is soluble in water, and the solution 
affords white precipitates with ammonia, chloride of barium, ferrocya- 
nide of potassium, and hydrosulphate of ammonium. The precipitate 
thrown down by ammonia is wholly soluble in an excess of the alkali. 
Dose, gr. i— grs. vj. 

Zinci Acetas. — Acetate of zinc. In micaceous crystals, which ef- 
floresce in a dry atmosphere. It is soluble in 3 parts of water, and its 
solution yields white precipitates with ferrocyanide of potassium and 
hydrosulphate of ammonium. The salt is decomposed by sulphuric 
acid, with the escape of acetous vapors. Dose. gr. ss — grs. ij. 

Liquor Zinci Chloridi. — Solution of chloride of zinc. An aqueous 
solution, containing about 50 per cent of the salt. 

Zinci Chloridum. — Chloride of zinc. A white deliquescent salt, 
wholly soluble in water, alcohol, and- ether. Its aqueous solution 
yields with nitrate of silver a white precipitate, insoluble in nitric acid. 
(These preparations are for external use only.) 

Zinci Vcderianas. — Valerianate of zinc. A white anhydrous salt, 
in the form of pearly scales, having a faint odor of valerianic acid, and 
a metallic styptic taste. It dissolves in one hundred parts of water, 
and in forty of alcohol of the specific gravity of 0*833. Dose, gr. ^ 

— g r - J- 

Unguentum Zinci Oxidi. — Ointment of oxide of zinc. (Oxide of 
zinc, 20 parts ; benzoinated lard, 80 parts.) 

Antagonists and Incompatibles. — Lime-water, the alkalies and 
their carbonates, nitrate of silver, and the vegetable astringents, are 
incompatible with zinc-salts. The acetate of lead is also incompati- 
ble, but a solution containing sulphate of zinc and acetate of lead, not- 
withstanding the double decomposition which ensues, is an effective 



$00 AGENTS INCREASING WASTE. 

injection in gonorrhoea. With valerianate of zinc, acids, many of the 
metallic salts, soluble carbonates, and vegetable astringents, are incom- 
patible. The antidotes to be used in cases of poisoning by the zinc- 
salts are lime-water, mucilaginous drinks, milk, tannic acid, the carbon- 
ated alkalies, common soap, etc. 

Synergists. — The mercurial, silver, antimonial, and copper prepa- 
rations favor the action of the zinc-salts. 

Physiological Actions. — The preparations of zinc are active in 
proportion to their solubility and power of diffusion. The chloride, 
the sulphate, and the acetate, are the most active, and in the order in 
which they are placed ; the carbonate and the oxide being insoluble, 
have very feeble diffusive power, and possess consequently very slight 
activity. The chloride is a very active escharotic. Applied to the 
denuded integument, it sets up decided inflammation, and produces an 
intense burning pain, followed by sloughing. Owing to its great affin- 
ity for water and power of combination with albumen, it penetrates 
deeply and widely, and the eschar which it produces is thick, hard, 
and white. The dried sulphate of zinc (deprived of its water of crys- 
tallization by heat) is also feebly escharotic when applied to an open 
wound. Solutions of the sulphate and acetate act locally as astringents 
by combining with albumen. 

The soluble salts of zinc have a styptic metallic taste, which is very 
disagreeable. The sulphate of zinc is a very prompt and efficient 
emetic, acting without much preliminary nausea, and without much 
constitutional depression. It is a specific emetic ; it acts to produce 
emesis when injected into the veins. Long-continued use of the sul- 
phate, even in small medicinal doses, may excite ulceration of the mu- 
cous membrane. The oxide and carbonate, although insoluble and in- 
active, slowly produce systemic effects. The chloride is a powerful 
irritant poison, causing heat and a sense of constriction of the throat, 
a strong metallic taste, burning at the stomach, nausea, vomiting, 
great depression of the pulse, coldness of the surface, cold sweat, 
cramps of the legs, etc. The mind is unaffected. In a few instances 
nervous symptoms have followed, besides the cramps, and in one no- 
table case there was loss of the senses of taste and smell. 

All of the salts of zinc, when long continued, may produce a train 
of symptoms not unlike those caused by lead, viz., emaciation, pallor, 
loss of strength, constipation and colic, muscular weakness and trem- 
bling, paralysis, etc. The oxide in large doses, and used for a long 
period, has produced wasting, a fetid breath, gastro-intestinal catarrh, 
weakness, and feeble mind. 

The zinc-salts most probably exist in the blood in the form of al- 
buminate, and in close relation to the red blood-globules. They mani- 
fest much less tendency to accumulate, and are excreted much more 
rapidly than mercury, lead, and copper. They diffuse out of the blood 



ZINC. go! 

chiefly by the liver and intestinal glandular apparatus, and are found 
in great quantity in the faeces. To a slight extent they are also ex- 
creted by the kidneys. 

Therapy. — The sulphate of zinc is much employed as an emetic in 
cases such as narcotic poisoning, where prompt and efficient action is 
necessary. Six grains will generally prove sufficient. It may be re- 
peated every fifteen minutes,- well diluted with water, until emesis oc- 
curs. It was formerly much employed as an emetic in croup, but now 
tartar-emetic, but especially the subsulphate of mercury, is preferred. 

The oxide of zinc is an excellent remedy for gastralgia. It is indi- 
cated also in the following state of things : pain after taking food, 
nausea, intestinal pain, succeeded by prompt alvine discharges, the 
faeces being made up largely of undigested food. From five to ten 
grains mixed with aromatic powder and combined with morphine, if 
need be, may be given before each meal. In the summer diarrhoea of 
children, it is a very efficient remedy. It may be administered with 
bismuth and pepsin. ^ Bismuthi subnitrat., 3 j — 3 ij ; pepsinae 
sacch. (Sheffer's), 3 ss; zinci oxidi, grs. vj — grs. xij. M. Ft. pulv. no. 
xii. Sig. : One powder every four to six hours. In the chronic diar- 
rhoea both of children and adults the oxide of zinc (from two to ten 
grains) is serviceable under the same circumstances in which bismuth 
is presumed to be indicated, but it is a less pleasant remedy in action 
than the latter. The sulphate (gr. ss — grs. ij) often gives great relief 
in that form of dyspepsia which is the cause of oxaluria. In small 
doses, the sulphate, like most of the mineral remedies of this group, 
increases for a time the appetite and digestive capacity, but this effect 
is soon succeeded by gastro-intestinal catarrh, nausea, and loss of appe- 
tite. The sulphate, as well as the oxide, is an astringent ; it arrests 
the peristaltic movements and causes constipation, and is therefore 
an appropriate remedy in chronic diarrhoea and chronic dysentery. 
In its action and results it is similar to but less efficient than sulphate 
of copper. It may be combined with opium and ipecacuanha : 3 
Zinci sulphat., pulv. opii, pulv. ipecac, aa grs. xij. M. Ft. pil. no. xij. 
Sig. : One pill three or four times a day. 

The zinc preparations possess undoubted efficacy in certain disorders 
of the thoracic organs. The night-sweats of phthisis are often pre- 
vented by a pill of oxide of zinc and extract of belladonna (three 
grains of the former and half a grain of the latter) given at bedtime. 
The zinc is serviceable without the belladonna, but the combined action 
is more efficient. The sulphate of zinc, by virtue of its astringency, 
has been prescribed in bronchorrhcea, but other agents are now pre- 
ferred. The oxide of zinc is a serviceable prophylactic against the 
recurrence of the attacks of spasmodic asthma. It is also one of the 
numerous remedies which has been used with a varying degree of suc- 
cess in whooping-cough : $ Zinci oxidi, 3 j ; ext. belladonnas, grs. v. 



302 AGENTS INCREASING WASTE. 

M. Ft. pil. no. xx. Sig. : One pill three times a day as a prophylactic 
for asthma, and as a remedy for whooping-cough. The sulphate of 
zinc (gr. \ — gr. j) and extract of belladonna (gr. \ — gr. ss) may be 
used in combination for the relief of the same cases. It is highly 
probable that the sulphate of zinc, being more soluble, is much more 
efficient in the treatment of these neuroses of the digestive organs than 
the oxide. 

The preparations of zinc exert an influence upon the nervous system 
which has been and is called antispasmodic. In certain disorders of 
the nervous system, of which the chief manifestations are spasm and 
convulsion (clonic), they are sometimes very serviceable. Much has 
been said for and against the oxide of zinc as a remedy for epilepsy. 
A few cases are improved by it ; in the great majority it fails utterly. 
The author expresses with diffidence his conviction that this remedy 
is most useful in those cases in which the peripheric irritation has its 
origin in the stomach ; it acts by allaying irritability of the terminal 
filaments of the pneumogastric, and probably also by removing a dis- 
eased state of the gastric mucous membrane. Epileptiform vertigo 
and epileptiform angina pectoris, when they arise (as they not unfre- 
quently do) from gastric disorder of some kind, are sometimes cured 
by the oxide of zinc. The so-called nervous headache of hysterical 
women, nervous cough, and aphonia, due to uterine and ovarian irri- 
tation, are often relieved by the valerianate of zinc. Sulphate of zinc 
is one of the numerous remedies for chorea, acting in a manner similar 
to arsenic, but inferior to this agent in curative power. In neuralgia 
due to reflex irritation from the female pelvic organs, the preparations 
of zinc, notably the valerianate, are often extremely beneficial. $ 
Zinci valerianate 3 j ; ext. gentianse, 3 j ; ext. nucis vom., grs. v. M. 
Ft. pil. no. xx. Sig. : One pill three or four times a day. In chronic 
alcoholismus, to relieve the trembling, to diminish the appetite for 
strong drink, and to relieve the gastric catarrh, the oxide of zinc is 
very useful : J* Zinci oxidi, 3 j ; piperin., 3j. M. Ft. pil. no. xx. 
Sig. : One pill three or four times a day. 

External Uses. — The author has personal knowledge of several 
cases of caries cured by the injection of Yillate's solution. The fol- 
lowing is the composition of this fluid : Sulphate of copper, sulphate 
of zinc, of each 15 parts ; solution of subacetate of lead, 30 parts ; 
vinegar, 200 parts. The sinus or sinuses leading to the carious bone 
should be thoroughly injected with the solution. It need hardly be 
remarked that this treatment would not remove a sequestrum. 

An excellent caustic for the destruction of lujnis, epithelioma, and 
unhealthy ulcers, is the dried sulphate of zinc, which may be freely 
dusted over the affected surface. A superficial slough forms, the sepa- 
ration of which may be aided by a poultice. The most efficient escha- 
rotic consistent with safety is the chloride. ~No danger is to be ap- 



ZINC. 303 

prehended from its absorption, and the strength of the application 
may be easily regulated. For the destruction of malignant growths, 
chloride of zinc is applied of varying strength, by the admixture of 
different proportions of flour, or better, of powdered althea-root, so as 
to form a paste, sufficient water being added. One part of the chloride 
to two, three, four, or five parts of flour are the proportions advised 
by Dr. Canquoin. Instead of flour, the chloride may be mixed with 
anhydrous sulphate of lime. A very convenient and useful mode of 
applying chloride of zinc is, to mix it, while in a finely-powdered state, 
with its weight of gutta-percha melted with as little heat as possible. 
The mixture may be molded into any desired shape. The so-called 
" caustic arrows " are nothing more than chloride-of-zinc paste, dried 
and cut into arrow-like slips. These are inserted into the malignant 
growth, usually at its base, in order to separate it from the healthy 
tissues. 

The salts of zinc are useful applications to certain forms and stages 
of skin-diseases. In eczema, during the secretory stage, the following 
may be used : $ Zinci oxidi, 3 ij ; glycerinae, § ij ; liq. plumbi sub- 
acetat., 3 jss ; aquae calcis ad § vj. M. Sig. : Lotion (Fox). This 
formula is serviceable also in impetigo and herpes. An excellent ab- 
sorbent powder for excoriated surfaces is the following : fy Corn-meal, 
finely sifted, § iv ; oxide of zinc, § j ; iris powder, | ss ; oil of almonds, 
gtts. x. M. The following is recommended by Neumann in sebor- 
rhoea, when there is inflammation : 3 Zinci oxidi, 3 j ; plumbi car- 
bonat., 3 j ; cetacei, § j ; ol. olivae q. s. ft. ung. Sig. : Ointment, 
In erythema, intertrigo, and eczema, the following lotion is useful : I£ 
Aluminis, 3] ; zinci sulph., grs. x; glycerinae, 3 j ; aquae rosae, § iv. 
M. Sig. : Lotion. For erythema and herpes, the following may also 
be used : ^ Zinci acetat., grs. ij ; aquae rosae, 3 j ; ung. aquae rosae, 
| j. M. Sig. : Ointment. The ointments of the oxide of zinc and 
the cerate of the carbonate are excellent applications in many of the 
cutaneous affections above named. 

Probably the most efficient means for treating gonorrhoea consists 
in the use of a weak zinc-injection frequently repeated, ty Zinci 
chloridi, gr. j ; aquae rosae, | iv — 5 viij. M. Sig. : As an ii-ijection, 
^ Zinci sulph., grs. viij ; aquae rosae, § viij. M. Sig. : As an i?ijec- 
tion. After the acute symptoms have subsided, the following injec- 
tion is very effective : I£ Zinci sulphat., plumbi acetat., aa grs. viij ; 
ammoniae muriat., aluminis, aa grs. iv ; aquae rosae, % j. M. Sig. : As 
an injection. 

The sulphate of zinc is very much prescribed by the ophthalmolo- 
gists in conjunctivitis, otorrhoea, etc. It is usually associated with mor- 
phine and atropine. ^ Zinci sulphat., grs. ij — grs. viij ; morphinae 
sulph., grs. ij — grs. iv ; atropinae sulph., gr. ss — gr. j ; aquae rosae, § j. 
M. Sig. : For the eye. 



304 AGENTS INCREASING WASTE. 

Authorities referred to : 

Fox, Dr. Tilbury. On Diseases of the Skin, second American edition. 

Gubler, Dr. Adolphb. Commentaires Therapeutiques du Codex Medicamentarius. 

Hirt, Dr. Ludwig. Die KranTcheiten der Arbeiter, erster Theil, Breslau, 1871, p. 97, 
Ci seq. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 281, et seq., ZinJc- 
Prciparate. 

Simpson, Sir James Y. Clinical Lectures on Diseases of Women, American edition, 
1872, p. 195. 

Trousseau et Pidoux. Traite de Therapeutique et de Matiere Medicale, eighth edition, 
by Paul. 

Waldenburg und Simon. Handbuch der allgemeinen und speciellen Arzneiverordnungs- 
Lehre, Berlin, 1873. 

Antimonium. — Antimony. Antimoine, Fr. ; Antimon, Ger. 

Antimonii et Potassii Tartras. — Tartrate of antimony and potas- 
sium. Tartar-emetic. In transparent crystals, which become white 
and opaque on exposure to the air. It is wholly soluble in twenty 
parts of water. The solution yields no precipitate with chloride of 
barium, or, if very dilute, with nitrate of silver. Hydrosulphuric acid 
causes an orange-red precipitate. A solution containing one part in 
forty of water is not disturbed by an equal volume of a solution of 
eight parts of acetate of lead in thirty-two of water and fifteen of 
acetic acid. Dose, gr. -^ — grs. ij. 

Emplastrwn Antimonii. — Antimonial plaster. (Not official.) 
(Tartrate of antimony and potassium, f j ; Burgundy pitch, § iv. ) 

TInguentum Antimonii. — Antimonial ointment. (Not official. ) 
(Tartrate of antimony and potassium, 100 grains ; lard, 400 grains.) 

Yinuni Antimonii. — Wine of antimony. (Tartrate of antimony 
and potassium, 4 parts ; boiling distilled water, 60 parts ; stronger 
white wine to make 1,000 parts.) Nearly two grains to the ounce. 
Dose, tt^v — 3 ij. 

Mistura Glycyrrhizoe Composita. — Compound glycyrrhiza mixture. 
(Brown mixture. Contains extract of glycyrrhiza, paregoric, nitrous 
ether, and wine of antimony. ) Dose, a tea to a tablespoonf ul. 

Syrupus Scillce Compositus. — Compound sirup of squill. Hive- 
sirup. (Squill, seneka, tartar-emetic. Contains about three fourths 
of a grain of tartar-emetic to the ounce.) Dose, v\ v — 3 j. 

Antimonii Oxidum. — Oxide of antimony. A grayish-white pow- 
der, insoluble in water, but readily and wholly soluble in muriatic or 
tartaric acid. Dose, gr. j — grs. iij. 

Antimonii Sulphidum Purificatum. — Purified sulphide of anti- 
mony. A dark-gray powder, odorless and tasteless, and insoluble in 
water or alcohol. Dose, gr. \ — gr. j. 

Antimonii Sidphiiratam. — Sulphurated antimony is a reddish-brown 
powder, insoluble in water. Dose, gr. 3 — grs. v. 

In the remarks which follow, tartar-emetic is the only antimonial 



ANTIMONY. 305 

preparation referred to, unless otherwise stated. None of the other 
preparations are employed by modern physicians. 

Antagonists and Incompatibles. — Tannic and gallic acids, and 
vegetable infusions containing them, form an insoluble tannate, and 
are therefore incompatible. Alkalies and the salts of lead decompose 
tartar-emetic. It follows that the proper antidotes to poisoning by 
tartar-emetic are tannic acid and substances containing it. Opium, 
alcohol, ether, etc., and the antispasmodics generally, are physiologi- 
cally antagonistic. 

Synergists. — The mineral substances of this group promote the ac- 
tion of the antimonials ; also the emetics and cathartics, and depress- 
ing remedies generally, as veratrum viride, etc. 

Physiological Actions. — Tartar-emetic has a sweetish, styptic, 
and metallic taste. In small medicinal doses, it excites a sensation of 
warmth in the stomach, followed by nausea, increased flow of saliva 
and buccal mucus, an abundant secretion of the gastric and intestinal 
glandular apparatus, and also of the liver and pancreas. In somewhat 
larger doses — a half-grain to one or two grains — it excites vomiting, 
first of the contents of the stomach, then of gastric mucus, and after- 
ward of mucus and biliary matters. The alvine dejections, are more 
fluid and increased in number, and consist at first of fluidified fasces ; 
afterward they are made up of a colored liquid, in which there are 
present biliary matters and some faeces ; and, finally, there appears 
only a colorless or whitish liquid, having flocculi of epithelium floating 
in it, and bearing a striking resemblance to the " rice-water discharges " 
of cholera. 

The gastro-intestinal symptoms are accompanied by systemic dis- 
turbance — paleness of the face, coldness of the surface (sometimes pre- 
ceded by a very temporary rise of temperature), irregularity and fee- 
bleness of the pulse, and great nervous and muscular prostration. 
When the quantity is sufficient to cause lethal symptoms, they are as 
follows : epigastric pain, vomiting and purging, shrunken features, 
cold breath, cyanosis, arrest of the urinary secretion, aphonia, cramps 
— the assemblage of symptoms belonging to the collapse of cholera. 

Tartar-emetic, when used in considerable medicinal doses, sets up 
an irritation of the fauces followed by aphthous ulcerations, which con- 
tinue along the oesophagus to the stomach, and are accompanied by 
salivation and painful deglutition. 

Applied to the skin by friction, tartar-emetic excites a follicular 
inflammation, succeeded by a papule, a vesico-pustule, a surrounding 
inflammation with indurated base, a central umbilication, and finally 
desiccation, terminating in a brownish scab. These antimony-pustules 
are very similar to those of vaccine or variola. 

When applied to the skin or injected into the veins, tartar-emetic 
is absorbed, and manifests a selective action on the gastro-intestinal 
21 



306 AGENTS INCREASING WASTE. 

mucous membrane, causing the same irritant effects as are produced 
by its stomach administration. It is, therefore, a specific, and not a 
merely irritant emetic. 

Tartar-emetic readily diffuses into the blood. In what form, unless 
as an albuminate, it exists in the blood, is not understood. It dimin- 
ishes the number and force of the arterial pulsations, and rapidly low- 
ers the blood-pressure. The pulse may fall from 72 to 40, but, accord- 
ing to Hirtz, rarely is the number reduced more than 6 to 10 per min- 
ute. In the healthy subject, the normal temperature, even when a 
full medicinal dose has been administered, remains unaffected as to 
the trunk, but it may be reduced in the extremities. In fevers and 
inflammations, a considerable reduction of temperature may take 
place, and the same result has been noted in the physiological state 
when the quantity of tartar-emetic has been sufficient to produce 
choleriform symptoms. 

In man delirium, and in animals paralysis, motor and sensory, but 
without impairment of muscular contractility, have been observed from 
lethal doses of tartar-emetic. 

Tartar-emetic promotes waste and hastens the elimination of the 
products -of waste — the excretion both of carbonic acid and of urea 
being greatly increased by it. 

The antimonial salts are found in the blood, in the liver, and other 
viscera, and are excreted by the bile, the milk, the perspiration, and 
the urine. It is, doubtless, also largely excreted by the intestinal 
glandular apparatus, as is the case with the metals generally. 

If tartar-emetic is administered in small doses, and the quantity be 
gradually increased, the nauseating effects of the drug may be en- 
tirely prevented. When emetic doses even are continued in some 
subjects, this effect finally ceases, and the drug is borne without pro- 
ducing any gastric symptoms. To this state has been applied the 
term tolerance, by the contra-stimulant school of practitioners. It 
must not be lost sight of, that this tolerance, on the part of the stom- 
ach, of large doses does not mean an indifference to the action of the 
remedy, but very serious and profound anatomical alterations may 
result. 

Therapy. — Tartar-emetic was, formerly, much more frequently 
prescribed than at present as an emetic in cases of indigestion charac- 
terized by a coated tongue, loaded stomach, and anorexia (Vembarras 
gastrique). It is sometimes used as an emetic in cases of narcotic poi- 
soning, but sulphate of zinc is preferable. It was formerly used as 
an emetic in the first stage of typhoid and other fevers, but, notwith- 
standing this practice is frequently followed by good results, it is now 
rarely pursued. If emesis is desirable in these cases, a less irritating 
and depressing emetic should be used. 

In croup tartar-emetic is an efficient emetic, but it must be used 



ANTIMONY. 307 

with caution, owing to the great depression which it produces, and the 
fatal result which has occurred in many instances. It is not a suitable 
remedy for infants and very young children. The compound sirup of 
squills is a domestic remedy for croup, but the incautious use of this 
has proved fatal. Tartar-emetic is used in laryngismus stridulus to 
produce emesis and consequent relaxation of the muscles of the larynx, 
and in true croup to cause the expulsion of the false membrane. The 
yellow subsulphate of mercury is safer and quite as effective. 

Tartar-emetic is an excellent remedy in the first stage of acute ca- 
tarrh, nasal, pharyngeal, and bronchial* It is most efficient in the 
first stage, when the mucous membrane is dry and swollen. It pro- 
motes secretion, diminishes fever, induces diaphoresis, and hastens the 
elimination of inflammatory products. In these cases, from one 
twentieth to one twelfth of a grain is usually a sufficient quantity, for 
it is not necessary that nausea be excited. When cough is violent, a 
little opium may be added to the prescription. I£ Antimonii et po- 
tassii tart., gr. ss ; morphinse acetat., gr. ss ; aquas, § ij. M. Sig. : A 
teaspoonful every hour or two. In acute bronchitis, when the cough is 
dry and hoarse, this agent is useful, and small doses (one sixteenth of 
a grain), frequently repeated, are more serviceable than large doses 
at longer intervals. 

Formerly, under the influence of the contra-stimulant school, tartar- 
emetic was given in large doses in pneumonia. It was sought to es- 
tablish tolerance at an early period, and to administer the largest doses 
which could be borne. The comparative results of this method of 
treatment and of the expectant and restorative plans demonstrate the 
impropriety of the tartar-emetic treatment, and it is now abandoned. 
It is true that small doses of tartar-emetic, by increasing the action of 
the skin, kidneys, and intestinal canal, may exert a favorable influence 
over the temperature and diminish the plasticity of the exudation ; but 
even small doses must be employed with care, lest a depression should 
be induced which may interfere seriously in the natural course of a 
disease which is self -limited and has its period of crisis. 

Tartar-emetic gives great relief in spasmodic asthma when the bron- 
chial secretion is deficient, and in those cases brought on by an over- 
loaded stomach. In the former case small doses frequently repeated 
until very slight nausea is produced, and in the latter emetic doses, are 
necessary. The following is a useful form of expectorant in the acute 
inflammatory affections of the air-passages : fy Antimonii et potassii 
tart., gr. j ; ammonii muriat., 3iv ; ext. glycyrrhizse, 3j ; morphinae 
muriat., gr. j ; syrup, tolutan., aquae lauro-cerasi, aa § j. M. Sig. : 
A teaspoonful every two, three, or four hours. 

The ointment of tartar-emetic was formerly much employed to pro- 
duce pustidation of the chest in the more chronic pidmonary diseases. 
This painful and disfiguring form of counter-irritation has passed out 



808 AGENTS INCREASING WASTE. 

of use. To produce a crop of variolus-like pustules on the skin does 
not cause a morbid process like caseous pneumonia or tuberculosis to 
cease its ravages ; on the contrary, such extensive suppuration in the 
skin rather favors the development of these diseases. 

A combination of tartar-emetic and opium is a serviceable hypnotic 
in some cerebral disorders. These remedies appear to be most useful 
when wakefulness and delirium are due to cerebral congestion, and 
in those subjects who become excited and wakeful from the use of 
opium alone. In the active delirium and wakefulness of typhoid fever, 
tartar-emetic and opium are prescribed : ~fy Antimonii et potassii tart., 
gr. j — grs. ij ; morphinse sulph., gr. jss ; aquas lauro-cerasi, § j. M. 
Sig. : A teaspoonfid every tvjo, three, or four hours. In delirium tre- 
mens, when the same conditions exist, the same combination may be 
prescribed. Since the introduction of chloral and bromide of potas- 
sium, however, the use of these drugs for the purposes just indicated 
has been much restricted. 

In acute inflammatory and febrile diseases, minute doses of tar- 
tar-emetic (gr. -^q), frequently repeated, render an incontestable ser- 
vice. Typhoid, typho-malarial, and remittent fevers, acute rheumatism, 
erysipelas, etc., are maladies thus benefited. This remedy is, of course, 
contraindicated when there is much irritability of the stomach and 
intestinal canal. At the outset of fevers it was formerly the custom 
to prescribe an active emetic, and good results certainly followed this 
practice. The author believes that he has frequently seen impending 
attacks of malarial fever aborted by emetic doses of antimony and 
ipecac. Free emeto-catharsis moderates the severity of remittent fever 
in robust subjects when produced in the incipiency of this disease, and 
also puts the mucous membrane in a better state for the disposition of 
medicines and food. 

Before the days of anaesthesia tartar-emetic was much used to relax 
the muscular system for the reduction of dislocations, to facilitate the 
taxis in strangulated hernia, to relax rigid os and perineum in labor, 
etc., but it is now no longer employed for these purposes. 

Authorities referred to : 

Gubler, Dr. A. Commentaires Therapeutiques du Codex Iledicamcntarius, p. 624, et seq. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, p. 218, Antimonsalze. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 218, et seq., Antimon- 
Praparate. 

Radziejetvsky, Dr. S. Schmidt's Jahrbucher da' gesammten Medicin, vol. cliii, p. 10, 
Zur Wirkung des Antimon. 

Taylor, Dr. A. S. On Poisons, American edition, p. 476. 

Trousseau et Pidoux. Traite de TMrapeutique et de Matiere Medicale, edition by 
Paul, tantieme edition, vol. ii, p. 951. 

Cadmium. — Cadmium. Cadmium, Fr. ; Kadmium, Ger. (Xot 
official.) C admit Sulphas. — Sulphate of cadmium. 



CERIUM. 309 

Action and Uses. — There is a strong resemblance — an identity 
of action, indeed — between zinc and cadmium, except that the latter 
is the stronger. Cadmium has a decidedly caustic and astringent 
taste ; it is powerfully nauseant and emetic, producing great depres- 
sion of the powers of life. Locally the effects are those of an irritant 
poison, and the systemic effects correspond ; although there are pro- 
duced such cerebro-spinal symptoms as coma and convulsions. This 
agent is not administered internally, the preparations of zinc being 
preferred for all purposes to which cadmium might be applied as a 
remedy. 

In ophthalmic practice, cadmium seems to be much esteemed as a 
collyrium. It is held to possess special powers in causing absorption 
of opacities of the cornea : 3 Cadmii sulph., grs. ij ; aquae rosoe, § ]• 
M. Sig. : Collyrium. A solution of the same strength is said to be 
an excellent local application in otorrhoea. There is no doubt that 
cadmium is an efficient injection in gonorrhoea ; but it is important in 
the application of this, as of so many other astringent remedies, that 
it be not too strong — one grain of cadmium sulphate to four ounces of 
water being sufficient in most cases. 

An ointment of cadmium is used somewhat by French physicians, 
in the treatment of external affections. For this purpose we may di- 
rect ten grains of the sulphate to be intimately incorporated with an 
ounce of simple ointment. 

Cerium. — Cerii Oxalas. — Oxalate of cerium. A white powder, in- 
soluble in water, alcohol, and ether. Dose, two to five grains in pill- 
form, as it is insoluble in the ordinary menstrua. It may be suspended 
in mucilage. 

Sir James Simpson was the first to propose the use of oxalate of 
cerium to restrain vomiting arising from various causes, especially 
from pregnancy ; and he brought forward many cases illustrative of 
its value. As he pointed out, it sometimes succeeds immediately, but 
usually the best effects are experienced after several days' use. The 
oxalate of cerium sometimes succeeds remarkably in vomiting due to 
serious organic lesions, as in cancer (Peters). It has been narrated 
in one case, that four grains were administered every two hours until 
about 600 grains were taken. The good result which followed this 
large administration of the drug indicates that, in vomiting from simi- 
lar causes, larger doses may be sometimes necessary to secure the best 
curative effects. In chronic diarrhoea, cerium may take the place of 
bismuth. 

In cases of cough associated with vomiting, excellent results have 
been obtained from the oxalate of cerium. It is probable that the 
cough is reflex in origin, the point of irritation existing in the terminal 
filaments of the pneumogastric in the gastric mucous membrane. 



310 AGENTS INCREASING WASTE. 

METALLOTHERAPY. 

Definition and Historical Development. — By the term metallother- 
apy is meant a curative method in which metals are applied to the 
affected area. 

The influence of the noble metals over the bodily functions has been 
believed in from the remotest times within the historical period, aud 
this belief has been acted on by many influential persons down to 
nearly our own era. The action of magnetic iron contributed to this 
mystical notion. Then came the wonder-working Mesmer. To the 
action of magnets was added that mysterious force evoked by the 
agencies employed by the Mesmerists. From such elements a pre- 
tended method of cure was elaborated, and a great many charlatans 
throve on the profits of the "system." Probably the most sustained 
success in this department of popular notions was effected by Dr. Per- 
kins, of Connecticut, who invented a combination of metals arranged in 
the form of a cylinder, about six inches in length and two inches in 
circumference, which he called a tractor. Provided with a suitable han- 
dle, the tractor was slowly passed over the affected area, and the morbid 
process was drawn out or dispersed. Perkins's tractors excited great 
interest in this country, and in England an immense enthusiasm. An 
institution — known as the Perkinian Institute — was established in Lon- 
don, and many of the nobility and gentry resorted to it to be cured by the 
application of the tractors. In a book published by the son, there may 
be found many certificates of cures thus effected. These results are the 
less surprising when interpreted by the aid of subsequent developments 
from metallotherapy. Mesmer, Perkins, Hahnemann, appeared nearly 
simultaneously, and the theories of these three apostles of new creeds 
were developed by the revolutionary spirit of the times, rather than 
by original study, and were not the products of a systematic applica- 
tion to the truths of such science as then existed. 

Metallotherapy, as now understood, had its origin in the experi- 
ments of Dr. Burq, which were first announced in a note addressed to 
the Academy of Sciences, and subsequently embodied in his thesis for 
the medical doctorate in 1851. He stated that a plate of metal — a sil- 
ver coin, for example — applied to the skin, may remove the paralyses 
of motility or of sensibility occurring in hysteria ; that the same metal 
was not equally successful in all cases, and that idiosyncrasies exist, so 
that in respect to each individual there is a special metal, active and 
curative. In one subject it may be gold, in another silver, and in a third 
copper, which has the power to restore the lost motility or sensibility. 
Burq also maintained that the same metal taken internally, whether in 
the form of a natural mineral water or in a pharmaceutical preparation, 
produced the same result. In other words, when a piece of metal, a 
coin, selected according to the special sensibility of the subject, is ap- 



METALLOTHERAPY. 311 

plied to an hysterical patient having permanent hemianesthesia, the 
return of the normal sensibility is effected in from ten to twenty minutes 
through a space of some extent, above and below the point of applica- 
tion. Numbness, tingling, and other disorders of sensation, dysesthe- 
sia, etc., precede the return of sensibility to the anesthetic area. The 
restoration of the sensibility proceeds from the point of application of 
the metal, and enlarges in all directions until the whole side returns to 
the normal. At the same time, an elevation of the temperature recog- 
nizable by the thermometer, and an increase of motor power as shown 
by the dynamometer, take place. These changes in the state of the sen- 
sory nerves are coincident with dilatation of the capillaries. The special 
senses undergo the same modifications. Sight, hearing, taste, and smell, 
are also in the condition of anesthesia, and as the general sensibility 
is restored, these special organs return to their normal state. 

Such, in brief, were the facts announced by M. Burq. A commis- 
sion, with M. Charcot at its head, was appointed to investigate the 
phenomena of metallotherapy. Hitherto the statements in regard to 
the effects of metals had been received with positive incredulity ; but 
the commission not only confirmed the accuracy of Burq's observations, 
but added some new facts. The first discovery made by them was the 
phenomenon of " transfer." By this term is meant a transference of 
functional powers. When the sensibility, the temperature, and the 
muscular power are restored to the side which had been anesthetic, the 
other or normal side loses a part of its general and special sensibility. 
The commission also ascertained that when metals are applied for the 
relief of hemianesthesia due to old organic lesions of the nervous cen- 
ters (such, for example, as cerebral hemiplegia), sensibility is restored 
also, but in a more durable manner. Thus, in a case of anesthesia of 
ten years' duration, produced by a cerebral lesion, this symptom yielded 
to the application of gold. Other instances of the same character, and 
equally significant, were reported by the commission. These facts led 
Charcot to entertain the supposition that the effects produced by the 
application of the metals are really due to electrical action. It was 
ascertained, indeed, that electrical currents measurable by the galva- 
nometer are caused by the contact of the metals, and, conversely, that 
electrical currents of corresponding strength induced the same results 
as the metals, including the phenomena of transfer. The intensity of 
the current varies with the metal. In the case of a patient impressionable 
to gold, a current of two to twelve degrees suffices to restore the sensi- 
bility and the muscular force, while in one sensitive to copper, a current 
of forty to fifty degrees is required to effect the same result (Petit). 

As was above stated, when the metal to which the subject is found 
to be sensitive when applied locally, is given by the stomach, the same 
result is reached — that is, the anesthesia is replaced by normal sensi- 
bility, the temperature rises to the natural level, and the muscular 



312 AGENTS INCREASING WASTE. 

power is restored. The commission discovered the remarkable fact 
that if, after the normal is thus resumed, the metal is again applied, the 
original anaesthesia comes on. To this return anaesthesia Charcot has 
applied the term metallic ancesthesia. A feeble electric current applied 
under the same conditions produces, also, a return anaesthesia, which 
is called postelectric. When the metallic plates applied to the skin are 
composed of metals superimposed, the same results as those obtained 
by a single metal are not produced. Thus, if in a patient sensible to 
gold a piece of silver is laid on the gold, the effects proper to the latter 
do not follow. The results due to the application of gold may be ren- 
dered durable in some cases by superimposing a piece of silver. If, 
after the effects produced by the application of a metal to which the 
patient is sensitive, another metal is placed above the first, the results 
due to the former may be fixed or rendered permanent. 

Notwithstanding the incredulity with which these observations on 
the action of metals were at first received, they have come to be gen- 
erally accepted. Prof. Westphal, after a study of metallotherapy at 
Paris, made some investigations at Berlin, which, on the whole, were 
confirmatory. Charcot's observations were also sustained by the ex- 
periences of Thompson, Horrocks, and Wilks. An important contri- 
bution to the subject was made by Dr. Hughes Bennett, when he found 
that other substances besides metals caused the same results. In this 
experience we have an illustration of the old and well-known fact that 
discoveries are being constantly reproduced. When the Perkins ex- 
citement was at its acme, Dr. Haygarth, of Bath, announced that 
wooden cylinders made in imitation of the genuine tractors had the 
same curative effects. It is clear, however, as M. Vigouroux has well 
said, that not all substances have the same action. This fact has also 
been demonstrated by Dr. Hack Tuke, who, having caused the anaes- 
thesia to disappear by the action of a metal, substituted a piece of car- 
bon of similar size and appearance, but the effect did not follow. 

Actions and Applications. — Charcot, as has been stated, supposed 
that the effects produced by the application of metals were due to elec- 
trical action. This theory does not suffice to explain all of the effects. 
By Dr. Tuke, " expectant attention " was invoked to explain the phe- 
nomena, but this theory is not tenable. "Vigouroux holds that the dif- 
ference in electrical tension of some point of the organism is the real 
explanation of the phenomena resulting from the application of metals 
to the surface. 

According to Burq, the order of susceptibility to the impression 
of metals is as follows, each individual, as a rule, being susceptible to 
one metal only : iron, copper, gold, silver, tin, platinum (only rarely). 
These metals are applied in the form of disks, or large coins, and some- 
times disks of wood coated with the metals. Some other substances, 
as mentioned above, have exhibited the same phenomena, but the met- 



ALUM. 313 

als are unquestionably the most important. The metallic disks or 
coins are placed as a bracelet around the limb to be acted on, or 
individual disks are held in position by a bandage. The effects fol- 
low in a few minutes. The skin, previously pallid, cold, and without 
sensibility, becomes flushed, warm, and acutely sensitive, and in a 
short time the special senses are restored to their normal functional 
activity. As has been described, corresponding losses occur on the 
other side. 

Metallotherapy has been employed chiefly for the restoration of 
sensibility in cases of the hemianesthesia of hysteria, of paralysis of 
sensibility, in some instances of hemiplegia, and of certain functional 
paralyses of motility. It is not possible to formulate a set of rules for 
distinguishing the cases which will be benefited by these applications. 
Sometimes remarkable results are reached in a few applications ; then, 
again, unaccountable failures occur. 

Cases of writer's cramp, and of chorea, among the spasmodic af- 
fections, and neuralgia, have been suddenly cured by the use of the 
esthesiogenic metal ; but failures are greatly more frequent than the 
successes. When the metal to which the patient is sensitive has been 
ascertained, the further treatment may be conducted by the internal 
use of the same. 

Authorities referred to : 

[The literature of this subject is now so extensive, that its enumeration would occupy 
space entirely out of proportion to its utility here. A few of the more important contri- 
butions are given.] 

Burq, M. These de Paris, quoted in Bull. Gen. de Therap., vol. xcvii, p. 33. 

Perkins, Benjamin Douglas, M. A., son of Dr. Perkins the discoverer. The Effi- 
cacy of Per kirn' 's Patent Metallic Tractors in Topical Diseases, etc., London, 1800. 

Petit, Dr. L. H. Sur la Metallotherapie. Bull. Gen. de Therap., vols, xcvii, xcviii. A 
series of papers. 

Tuke, Dr. Hack. Meialloscopy and Expectant Attention. Journal of Mental Science, 
January, 1879, p. 598. 

Vigouroux, Dr. Le Progres Medical, December 7, 1878, p. 944. 

Westphal, Prof. Dr. Berliner hlinische Wochenschrift, July 29, 1878. 

Alumen. — Alum. Alun, Fr. ; Alaun, Ger. 

Aluminis et Potassii Sulphas. — Potassa alum. A white, slightly- 
efflorescent salt, crystallizing in regular octahedrons, and possessing 
an acid, sweetish, astringent taste. It dissolves in from fourteen to 
fifteen times its weight of cold, and three fourths of its weight of boil- 
ing water, but is insoluble in alcohol. 

Alumen Exsiccatum. — Dried alum. Alum deprived of its water of 
crystallization by heat. A white, granular powder, odorless, but hav- 
ing a sweetish, astringent taste. Slowly but completely soluble in 
twenty parts of water at 60° Fahr. 

Aluminis Sulphas. — Sulphate of aluminum. Has a sour, somewhat 



3U AGENTS INCREASING WASTE. 

sweetish, and astringent taste, and an acid reaction. It is soluble in 
twice its weight of water. 

Antagonists and Incompatibles. — Alkalies and their carbonates 
and acetate of lead are chemically incompatible. 

Synergists. — The mineral and vegetable astringents promote its 
therapeutical activity. 

Physiological Actions. — The sweetish taste of alum first experi- 
enced is quickly followed by a decided astringency. It provokes an 
abundant flow of saliva, and the albumen of the saliva and buccal 
mucus is coagulated in whitish, membrane-like flakes. Contraction of 
the capillaries, blanching of the mucous membrane, and subsequent 
diminution of secretion, take place ; hence the dryness of the throat, 
thirst, and constipation, which result from its use. In doses of a tea- 
spoonful, or more, alum is an efficient emetic. Under certain morbid 
states it also proves laxative. Notwithstanding its power to coagulate 
albumen, it is absorbed into the blood, as was shown by Orfila, and 
may be found in the liver and in the urine. Circulating in the blood, 
alum affects the capillaries, diminishing their caliber, lessens secretion, 
especially of the mucous membranes, and arrests haemorrhage. In very 
large doses alum produces decided irritant effects — nausea, vomiting, 
abdominal pain, diarrhoea, etc. 

Dried alum, in consequence of its strong affinity for water, and its 
power to coagulate albumen, is a mild escharotic. 

Therapy. — Alum is one of the remedies which may be used in 
gastric catarrh. It is said to be most effective when there is vomiting 
of glairy mucus. 1^ Aluminis, 3 ij ; extract, gentian., 3 ss. M. Ft. 
pil. no. xxx. Sig. : Two pills three times a day. Alum is a service- 
able haemostatic in hmmatemesis. It is, of course, adapted only to 
cases of passive haemorrhage, when there is a relaxed condition of 
the mucous membrane. Other astringents — as, for example, Monsel's 
salt — are more effective. When intestinal haemorrhage is dependent 
on mechanical causes (cirrhosis, for example), and the mucous mem- 
brane is free from acute inflammation, alum is a serviceable astringent. 
It was formerly much used in chronic diarrhoea and chronic dysentery, 
but more effective agents are now employed in these diseases. The 
following formulae are applicable to the above-mentioned diseases, in 
the absence of more suitable agents : fy Aluminis, 3 ij ; pulv. aromat., 
3 j ; pulv. opii, grs. vj — grs. xij. M. Ft. pulv. no. vj. Sig. : One pow- 
der in honey or sirup three times a day or oftener. ty Aluminis, 3 j ; 
extract, opii, grs. x ; catechu, 3 j- M. Ft. pil. no. xx. Sig.: Two pills 
every two, three, or four hours. I> Aluminis, 3 ij ; pulv. opii, grs. iij 
— grs. vj ; pulv. kino, 3 j ; sacch. lactis, 3 j. M. Ft. pulv. no. vj. Sig.: 
One powder every three hours. 

It is a singular fact that the most effective agent for the cure of 
colica pictonum is alum. It relieves the pain and nausea, and over- 



ALUM. 315 

comes the constipation, more certainly than any other agent. The 
chemical theory of its action is entirely unequal to the explanation of 
its remarkable effects ; the conversion of any portion of the lead pres- 
ent in the intestinal canal into the insoluble sulphate would not suffice 
to quiet pain, relieve flatulence, and relax the obstinately constipated 
bowels. Its action is doubtless dynamical : it overcomes the relaxa- 
tion and paresis of the muscular layer, on which the phenomena of 
lead-colic depend. The following are convenient formulae for the ad- 
ministration of alum in this disease : £> Aluminis, 3 ij ; acid, sulphuric, 
dil., 3 j ; syrup, limonis, § j ; aquae, § iij. M. Sig. : A tablespoonful 
every hour or two. ^ Aluminis, 3 ij ; vini, § iv ; catechu, 3 j ; traga- 
canthae, 3 j ; aquae, f viij. M. Sig. : A tablespoonful every hour. 
Alum-whey, prepared as follows, may be used in lead-colic : To a pint 
of boiling milk, add ninety grains of alum-powder ; separate the curd, 
and sweeten the whey if desired with an ounce of white sugar. A 
wineglassf ul may be taken every hour or two. 

Alum not unfrequently affords relief in gastralgia, enter algia, and 
catarrh of the intestines. It is a serviceable laxative in females of lax 
fiber, in whom constipation depends upon a paretic state of the muscu- 
lar layer of the bowel. It is true that we possess many other agents 
more agreeable for administration, and also more effective ; but alum 
is cheap, and always to be obtained. 

Alum, dissolved in infusion or solution of the extract of logwood, 
is a useful injection in hemorrhage from the rectum, or as an applica- 
tion to bleeding piles, or as an astringent wash in prolapsus of the rec- 
tum in children. A crystal of alum, cut into a globular shape, may 
be passed into the rectum in such cases. The following ointment may 
be applied to haemorrhoids when they protrude, bleed, and are painful : 
$ Pulv. aluminis, 3 ij ; pulv. camphorae, pulv. opii, aa 3 j ; unguent., 
1 j. M. Sig. : Ointment. 

Notwithstanding the theoretical objections which have been made 
as to its utility, the use of alum is sanctioned by high authority in 
hemorrhages from distant organs of the body. Oppolzer recom- 
mends the following formula : I£ Aluminis, amyli, aa 3 j ; sacchari, 
3 ij. M. Ft. pulv. no. vj. Sig. : One powder every two hours. Skoda 
advises the following formula in hemoptysis : ^ Aluminis, 3 j ; sacch. 
alb., 3 ss ; pulv. ipecac, comp., 3j. M. Ft. pulv. no. vj. Sig.: One 
powder every two hours. 

Alum was formerly used in diabetes mellitus, but more effective 
methods of treatment have taken its place. Good results have cer- 
tainly been produced by the use of alum in diabetes insipidus. Colli- 
quative sweats are moderated by the internal use of alum, and by 
sponging the surface with a solution. 

Alum has been used with a certain measure of success in ivhoop- 
ing-cough, during the spasmodic stage, but the more certain and pal- 



316 AGENTS INCREASING WASTE. 

atable remedies now in our possession have quite displaced it. As an 
emetic in croup, there is no doubt of the utility of alum. It is used 
to cause the dislodgment of the false membrane, and to prevent its 
re-formation. It acts without depressing the bodily functions, is 
prompt and thorough. A teaspoonful of the powder, mixed with 
honey or sirup, may be given, and repeated every half -hour until free 
emesis occurs. 

External Uses of Aluji. — A solution of alum in nitric ether is 
said to be an effective application in toothache ( 3 ij — 3 vij). When 
the gums are spongy and ill-conditioned, and manifest a tendency to 
recede from the teeth, the following local application is very service- 
able : r^ Aluminis, 3 j ; vini, Oj ; tinct. cinchonae, 3 ss ; tinct. myrrhae, 
3 ij ; mel. rosse, 3 ij. M. Sig. : As a mouth-wash. When there 
is much relaxation of the faucial mucous membrane, alum and sugar, 
in equal proportions, may be applied by an insufflation-tube. Pow- 
dered alum, dusted over the affected surface, is a useful application 
in chronic pharyngitis, chronic tonsillitis, chronic nasal catarrh. Ul- 
cers of the mouth, whether syphilitic, or due to nursing, or arising 
from gastric disorder, are improved in character by application of a 
crystal of alum. A useful gargle in various affections of the mouth 
and throat is the following : r£ Infus. lini, J xv ; tinct. kino, § j ; 
aluminis, 3 ij. M. Sig. : As a gargle. 

In catarrhal ophthalmia, after the acute symptoms have subsided, 
an alum-lotion is useful : I> Aluminis, 3 j ; aquae rosae, 3 iv. M. 
Sig. : Lotion. Alum-curd is a domestic application which is often ser- 
viceable : 3 ss of alum to the white of an egg. 

The following is a useful injection in chronic gonorrhoea : r^ Alu- 
minis, 3 j ; zinci sulphatis, 3 ss ; sodii biborat., grs. iv ; aquae rosae, 
§ viij. M. Sig. : An injection. This prescription is equally applica- 
ble to leucorrhoea. 

Alum is a useful hemostatic, but there are others more powerful. 
Alum is a constituent of the once famous Pagliari's mixture (Men- 
tel's) : 3 Benzoini, gr. c ; alcohol, fort., f ss. Dissolve and add 
water, § x ; alum, 3 j. The mixture is to be boiled until clear, and, 
when cool, filtered. This is also a good preservative solution for 
anatomical preparations, and is an effective application in leucorrhoea, 
pruritus of the vulva, etc. 

Alum 1 ss, the whites of four eggs, and tincture of camphor § ij, is 
an excellent application to bed-sores. Burned alum is a mild escha- 
rotic, which is sometimes used to destroy exuberant granulations. 

Authorities referred to : 

Gubler, Dr. A. Commentates de Therapeutique, etc., p. 433. 
Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 311. 
Trousseau et Pidoux. Traite de Therap., etc., vol. i, p. 188. 
Waloenburg und Simon. Handbuch der Arzneiverordnungs-Lehre, p. 154. 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 317 

Acidum Tannicum. — Tannic acid. Ihnin, Fr. ; Tanninum, Ger. 

Tannic acid has a yellowish-white color, and strongly astringent 
taste. It is soluble in 6 parts of water, in 0*6 part of alcohol, and 
in 6 parts of glycerin. Its solution reddens litmus, and produces, 
with solution of gelatin, a white, floccalent precipitate ; with the salts 
of the sesquioxide of iron a bluish-black precipitate ; and with solu- 
tions of the alkaloids white precipitates, very soluble in acetic acid. 
Dose, gr. j— 3j. 

Collodium Stypticum. — Styptic collodion. (Tannic acid, 20 parts ; 
alcohol, 5 parts ; stronger ether, 20 parts ; collodion, 55 parts.) 

Trochisci Acidi Tannici. — Troches of tannic acid. (Each troche 
contains one grain of tannic acid.) 

Unguentum Acidi Tannici. — Ointment of tannic acid. (Tannin, 10 
parts ; benzoinated lard, 90 parts.) 

Suppositoria Acidi Tannici. — Suppositories of tannic acid. (Not 
official.) (Tannin, 3 j ; ol. theobromaB, 3 v.) 

Acidum Gallicum. — Gallic acid. Acide gallique, Fr. ; Gdllapfel- 
$aure y Ger. 

Gallic acid is in small, silky, nearly colorless crystals, having a 
slightly acid and astringent taste. It is soluble in one hundred parts 
of cold, and in three of boiling water. The solution reddens litmus, 
and does not produce a precipitate with a solution of gelatin, or of 
sulphate of protoxide of iron. With solutions of salts of sesquioxide 
of iron, it produces a bluish-black precipitate, the color of which dis- 
appears when the liquid is heated. It is decomposed by a strong heat, 
and entirely dissipated when thrown on red-hot iron. Dose, gr. j — 
grs. x. 

Unguentum Acidi Gdllici. — Ointment of gallic acid. (Gallic acid, 
10 parts ; benzoinated lard, 90 parts.) 



The following remedies contain a tannic acid, and have physio- 
logical and therapeutical actions due to the presence of this sub- 
stance : 

Galla. — Nutgall. JVoix de galle, Fr. ; GaUapfel, Ger. 

Tinctura Gallce. — Tincture of galls. Dose, 3 ss — 3 ij. 

Unguentum Gallce. — Ointment of galls. (Galls in fine powder, 10 
parts ; benzoinated lard, 90 parts. 

Composition. — Tannic acid (gallo-tannic), 60 to 70 per cent ; gallic 
acid, 3 per cent ; sugar, resin, etc. 

Catechu. — Catechu. An extract prepared principally from the 
wood of Acacia catechu. Cachou, Fr. ; Katechusafe, Ger. 



31S AGENTS INCREASING WASTE. 

Tinctura Catechu Composita. — Tincture of catechu. (Catechu, 12 
parts ; ciunamoni., 8 parts ; diluted alcohol, a sufficient quantity to 
make 100 parts.) Dose, tti x — 3 j. 

Infusion Catechu Compositum. — Compound infusion of catechu. 
(Not official.) (Catechu, 3 ss ; cinnamon, 3 j ; boiling water, Oj.) 
Dose, 3 j — I ss.). 

Trochisci Catechu. — Troches of catechu. Each troche contains 
one grain of catechu. 

Composition. — Catechin, or catechuic acid. 

Kino. — Kino. The inspissated juice of Pterocarpus marsupium, 
and of other plants. Kino de VInde, Fr. ; Kino Gummi, Ger. 

Tinctura Kino. — Tincture of kino (10 parts to 100). Dose, m, x 
— 3 ij. 

Composition. — Kino-tannic acid. 

Krameria. — Rhatany. The root of Krameria triandra and of K. 
tomentosa. Matanhia, Fr. ; Ilatanhiaiourzel, Ger. 

Extractum Krameriai. — Extract of rhatany. Dose, grs. v — grs. x. 

Tinctura Krameriai. — Tincture of rhatany (20 parts to 100). Dose, 
tti v— 3 j. 

Extractum Krameriaa Fluidum. — Fluid extract of rhatany. Dose, 
ni v — 3 ss. 

Composition. — Ratanhia-tannic acid ; odorous principle ; wax, 
gum, etc. 

Haematoxylon. — Logwood. The heart-wood of Kmmatoxylon Cam- 
pechianum. JBois de Campeche, Fr. ; Campecheholz, Ger. 

Decoctum Hcematoxyli. — Decoction of logwood. (Not official.) 
(Logwood, 3 j ; water, Oij, boiled down to Oj.) Dose, 3 ss — § j. 

Extractum, Hcematoxyli. — Extract of logwood. Dose, gr. v — 3 j. 

Composition. — Hematoxylin, tannic acid, etc. 

Geranium. — Cranesbill. The rhizoma of Geranium maculatum. 

Extractum Geranii Fluidum. — Fluid extract of geranium. Dose, 
m v— 3 j. 

Composition. — Tannic and gallic acids, resin, gum, starch, chloro- 
phyll, etc. 

Quercus Alba. — White-oak bark. 

Quercus Tinctoria. — Black-oak bark. (Not official.) £corce de 
chene, Fr. ; Eichenrinde, Ger. 

Decoctum Quercus Albce. — Decoction of white-oak. (Not official.) 
( I j— Oj.) Dose, I ss— I j. 

Composition. — Quercitrin or quercitric acid, tannic acid, etc. 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 319 

Rosa Gallica .— Red rose. The petals of Rosa Gallica. Roses 
rouges, Fr.; Fssigrosoi, Ger. 

Confectio Rosoe. — Confection of rose. 

Extr actum Rosce Fluidum. — Fluid extract of rose. Dose, m, v — 3 ij. 

Mel Rosm. — Honey of rose. 

Composition. — Tannic and gallic acids, quercitrin, coloring matter, 
volatile oil, etc. 

Rubus. — Blackberry-root. Bark of the root of Rubus Canadensis 
and Rubus villosus. 

Extr actum Rubi Fluidum. — Fluid extract of rubus. Dose, t\[ x 

-3ij. 

Composition. — Tannic acid, etc. 

Myrica Cerifera.— Bayberry, wax-myrtle. (Not official.) Bark of 
the stem and root. 

Decoction is made by boiling an ounce in a pint of water — dose, 
1 ss — § j. An alcoholic extract (myricine of the eclectics) — dose, 
grs. v ; and a fluid extract — dose, 3 ss — 3 ij — are to be obtained in the 
shops. 

Composition. — Tannic and gallic acids, myricinic acid, resin, red 
coloring matter, etc. 

The most important property is the astringency due to the large 
quantity of tannic and gallic acids. In large doses it is emetic. 

Statice Limonium. — Marsh rosemary. (Not official.) The root. A 
docoction ( § j — Oj) may be used — dose, | ss — § j. A fluid extract is 
prepared — dose, rq, xx — 3 j. 

Composition. — Tannic acid (twelve per cent), gum, extract, etc. 

Alnus Serrulata. — Common alder. (Not official.) The bark in de- 
coction ( § j — Oj) — dose, f ss — J j. Fluid extract — dose, n[ x — 3 j. 
Alcoholic extract (alnuin of the eclectics) — dose, gr. j — grs. v. 

Composition. — Tannic acid, oil, resin, etc. 

Heuchera. — Alum-root. Root of Heuchera Americana. (Not offi- 
cial.) Decoction — dose, f ss — f j ; fluid extract — dose, f\[ x — 3 j. 
Composition. — Tannic acid, etc. 

Hamamelis. — The leaves of Hamamelis Virginica. Witch-hazel. 

Extractum Hamamelidis Fluidum. — Fluid extract of hamamelis. 
Dose, in, x — 3 ij. 

Composition. — Tannic acid, volatile oil, etc. 

The extraordinary claims put forth of late years as to the powers 
of hamamelis originated with the proprietor of a secret formula. The 
author, as well as other investigators, ascertained that it has no physio- 
logical effect, except that which belongs to an agent rich in tannin. 



320 AGENTS INCREASING WASTE. 

Nymphaea Odorata. — Sweet-scented water-lily. Root. Decoction 
( 3 j — Oj) — dose, 3 ss — 3 j. Fluid extract — dose, 3 ss — 3 j. (Not 
official.) 

Composition. — Tannic acid, gallic acid, etc. 

Castanea. — Leaves of Castanea vesca Linne (Nat. Ord. Cupuliferce)^ 
collected in September or October, while still green. (U. S. P.) 
Composition. — Tannic acid, etc. 

Antagonists and Incompatibles. — The mineral acids, the salts 
of antimony, lead, and silver, and the persalts of iron, and alkalies, 
are chemically incompatible. The vegetable alkaloids and gelatin 
form insoluble precipitates. 

Synergists. — Tonics and bitters, as a rule, favor the action of 
tannic and gallic acids, and of the substances containing them. The 
agents comprehended in this group — or remedies whose chief result is 
to increase waste — are synergistic. 

Physiological Actions. — Tannin has a bitter astringent taste, and 
constringes the mucous membrane. In the stomach it enters into com- 
bination with albumen, and with the pepsin of the gastric juice, which 
it precipitates from its solution. Tannin, therefore, impairs digestive 
power by rendering the pepsin inoperative. It diminishes secretion of 
the mucous membrane by virtue of its power to contract the caliber of 
the vessels, and it restrains peristalsis by its action on the muscular 
layer ; hence the constipating effects which follow its use. If long 
continued in considerable quantity, tannin disorders digestion, sets up 
irritation of the mucous membrane, and gives rise to a febrile state 
and to wasting of the tissues. 

Having such affinity for and coagulating action on albumen, it is 
obvious that tannin must diffuse into the blood with difficulty. A 
part undergoes conversion into gallic and pyrogallic acids in the 
stomach, and in this form is absorbed. Injected into the veins, tannic 
acid coagulates albumen, and the results which follow are due to mul- 
tiple embolisms. Elimination of tannin takes place by the intesti- 
nal canal and by the kidneys, in the form of gallic and pyrogallic 
acids. 

Therapy. — Catarrh of the stomach, a relaxed state of the mucous 
membrane, acidity, and flatulence, are conditions in which tannic acid 
is useful. It may be given in pill-form with sufficient glycerin to 
make a mass of proper consistence — one drop to four grains. Haima- 
temesis dependent on ulcer of the stomach, or obstructive disease of 
the liver, and not inflammatory in origin, is an indication for tannin. 
It should be given in solution and in a large dose — grs. x — 3 j. Tan- 
nic acid is an efficacious remedy in diarrhoea, after acute symptoms 
have subsided, in chronic diarrhoea, colliquative diarrhoea, the diarrhaza 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 321 

of phthisis, etc. Notwithstanding the chemical incompatibility, com- 
bination with opium or morphine increases the efficacy of the tannin. 
As tannic acid, in large part, at least, escapes conversion into gallic, and 
passes unchanged into the intestine, its action is doubtless chiefly local. 
Oppolzer advises the following formula in profuse diarrhoea: $ Acidi 
tannici, 3 ij ; pulv. opii, grs. vj ; sacchari, q. s. M. Ft. pulv. no. 
vj. Sig. : One every two hours. In cholera diarrhoea, A. von Graefe 
prescribed a solution of tannic acid in cinnamon- water and mucilage 
every half -hour. For the diarrhoea and intestinal haemorrhage of ty- 
phoid fever, tannin is one of the most serviceable remedies. Accord- 
ing to Stille, whose faith appears rather extravagant, there is no more 
effective remedy for chronic diarrhoea and chronic dysentery than tan- 
nic acid conjoined with a milk-diet. 

Various members of this group are used in the above-mentioned 
diseases. Kino has been a favorite remedy in pyrosis, and is also 
given in diarrhoeal diseases. Catechu, in the form of the tincture 
chiefly, is frequently added to prescriptions for diarrhoea, notably to 
chalk-mixture in the diarrhoea of children. Kino is a favorite remedy 
for the diarrhoea of phthisis, but it is not more efficacious, and is more 
disagreeable in administration, than tannic acid. Several of the in- 
digenous remedies mentioned above possess undoubted value in the 
treatment of diarrhoeal diseases. A decoction of rubus or geranium, 
obtained by boiling the root in milk ( 1 j — Oj), is an excellent remedy 
in cholera infantum and the summer diarrhoea of children. When a 
nursing child passes rather frequent, greenish, and watery stools, and 
suffers with pain and colic at each motion, great relief will be afforded 
by the use of syrupus rubi, or better by the unofficial compound sirup 
of rubus. In the chronic diarrhoea of adults, and in acute diarrhoea 
after the subsidence of inflammatory symptoms, the fluid extracts of 
hamamelis, of heuchera, and of statice, may be used with advantage. 
In hcematemesis and intestinal haemorrhage the hamamelis is very ef- 
fective, owing, doubtless, to the very large percentage of tannin which 
it contains. 

The comparative merits of tannic and gallic acids may be formu- 
larized as follows : for local effects tannic acid, for systemic effects 
gallic acid is to be preferred. It is true that tannic acid affects re- 
mote parts, but in order to diffuse into the blood it must first be con- 
verted into gallic, and hence the systemic actions are really due to the 
latter. It follows that gallic acid should be prescribed when the as- 
tringent effects on the tissues elsewhere than the intestinal canal are 
to be produced. Gallic acid is an effective remedy for pulmonary and 
renal haemorrhage. For the former we possess other agents more ef- 
ficient, but for the latter it is more uniformly successful than any other 
remedy. The success of rhatany, which was formerly much used in 
hematuria, was doubtless due to its tannic and gallic acids. In the 



322 AGENTS INCREASING WASTE. 

hemorrhagic diathesis, gallic acid is one of the remedies which may 
be used with advantage. Although it can not be combined with chalyb- 
eates, it may be given alternately with them. Whenever haemorrhage 
occurs in relaxed and debilitated constitutions — is passive in character 
— gallic acid may be combined with ergotine and digitalis : fy Acid, 
gallici, 3i; ergotine (aq. ex.), digitalis, aa 3]. M. Ft. pil. no. xx. 
Sig. : One every four hours. 

As gallic acid has the power to restrain secretion of mucous sur- 
faces, it may be prescribed, experience has shown with good effect, in 
chronic bronchial catarrh. When bronchiectasis exists, the good effects 
of the remedy are by no means conspicuous, but it is very serviceable 
when the bronchial catarrh is the result of the irritation extending 
from disease of the parenchyma of the lungs, or is produced by mitral 
or tricuspid regurgitation, or is the sequel of acute catarrh. In pyelitis 
and pyelo-nephritis, gallic acid and the remedies containing it diminish 
the purulent discharge, and retard changes in the mucous membrane. 
It is also a serviceable remedy in catarrh of the bladder. In these 
states, to insure as far as possible its rapid and complete diffusion into 
the blood, it should be given frequently and well diluted. As it is 
soluble in eight parts of rectified spirit, and as this solution mixes in 
all proportions with water without precipitation, a spirituous solution 
should be prescribed : fy Acidi gallici, 3 j ; spirit, vini rectif., ^ j. M. 
Sig.: A teaspoonfid in sufficient water every four hours. 

Gallic acid has the power to restrain the waste of albumen in cases 
of albuminuria. It is adapted to the acute forms — desquamative ne- 
phritis, the albuminuria following scarlatina, etc., and does not seem, 
according to the author's observation, to check in the least the loss of 
albumen in the chronic forms of albuminuria. Dr. AitBsn recommends 
the following formula : ^ Acidi gallici, 3 j — 3 ij ; acid, sulphuric, dil., 
3 ss ; tinct. lupuli, 3 j ; inf us. lupuli, § vj. M. Sig. : A tablespoonful 
three times a day. 

The following mixture is very effective in menorrhagia, hematu- 
ria, purpura hemorrhagica, and the hemorrhagic diathesis: r> Acidi 
gallici, 3 ss ; acid, sulphur, dil., 3 j ; tinct. opii deod., 3 j ; inf. rosae 
comp., | iv. M. Sig. : A tablespoonful every four hours or oftener. 

Hillier advises the following prescription for chronic diarrhoea in a 
child of two years : fy Acidi gallici, gr. xij ; tinct. cinnamomi comp., 
3 jss ; tincturae opii, n], viij ; aquae carui ad | ij. M. Sig.: Two tea- 
spoonfuls a dose. 

For the sweating of phthisis the following formula is useful : ]J 
Acid, gallici, 3 ss ; ext. belladonnas, gr. ij. M. Ft. pil. no. x. Sig. : 
Two pills at bed-hour. 

In addition to the foregoing internal applications of the vegetable 
astringents, it may be mentioned that a decoction of chestnut-leaves 
(castanea) has been used with much success in whooping-cough. As 



TANNIC ACID AND VEGETABLE ASTRINGENTS. 323 

both tannic and gallic acids have been employed with more or less 
service in this disorder, it is probable that the good effects of castanea 
are really due to the presence in it of these acids. The decoction of 
castanea may be drunk ad libitum, or the fluid extract may be admin- 
istered in drachm-doses. 

External Uses of Tannic Acid and Substances containing it. 
— Dr. B. W. Richardson has proposed a tannin solution, to which he 
has applied the term styptic colloid. It consists of a saturated solution 
of tannin in alcohol (one part to eight) mixed with collodion. This is 
an elegant application to restrain oozing of blood from a large surface, 
to unite incised wounds, to protect lacerated icounds, to remove fetor 
from decomposing animal matter, to change the character of foul 
ulcers, etc. The following formula was proposed by Monsel as a 
haemostatic : IJ Acidi tannici, 3 j ; aluminis, 3 ij ; aqua? rosse, § iij. 
M. Sig. : For external use as a haemostatic. The glycerite of tannin 
is a neat formula for external application. 

Tannic acid is much employed as an application to the mouth and 
throat in various diseases of these parts. In mercurial salivation an 
excellent application is a solution of tannin, with honey of roses : IJ 
Acidi tannici, 3 j ; mel rosse, § ij ; aqua?, 5 vj. M. Sig. : As a gargle. 
Elongated uvula, relaxed palate, and follicular pharyngitis, are effec- 
tively treated by insufflation of tannin, i. e., some finely-powdered tan- 
nin blown over the affected surface with a hand-ball insufflator. Epis- 
taxis may often be promptly arrested by passing through the nares a 
strong solution of tannin ( 3 ij — f iv) by means of a post-nasal syringe 
or nasal douche, or powdered tannin may be blown on the bleeding 
surface by an insufflator. The following is an excellent gargle for the 
more chronic throat-affections : IJ Acidi tannici, 3 ij ; spts. vini rect., 
3 j ; mist, camphor, ad J x. M. Sig. : An astringent gargle. In 
chronic affections of the larynx mucous membrane, and of the vocal 
cords, no inhalation is more frequently serviceable than a solution of 
tannin (grs. x — 3] — 1 iv) applied by means of the hand-ball or 
steam atomizer. This treatment is useful in chronic catarrh of the 
fauces, of the larynx, trachea, and bronchi, in ulcerations of the 
pharynx, larynx, and trachea, in bronchiectasis, in pulmonary hemor- 
rhage, gangrene of the lung, oedema of the glottis, croup, and diph- 
theria. 

The following is Druitt's prescription for toothache : IJ Acidi tan- 
nici, 3] ; mastich, grs. x ; etheris, § ss « M. Sig. : To be applied on 
cotton to a carious tooth. 

Tannin solutions of various strengths (gr. j — grs. x — 5 j) are use ^ 
in inflammation of the conjunctiva. Hairion advises a strong solution 
( 3 j — 3 iij) in acute and chronic conjunctivitis, granulations, corneitis, 
chemosis, and pannus. Yery remarkable results have been obtained 
by Dr. Hamilton, of Liverpool, in certain diseases of the eye by the 



324 AGENTS INCREASING WASTE. 

application of powdered tannin to the conjunctiva. This method con- 
sists in dusting over the everted lid finely-powdered tannic acid, using 
for this purpose a small rubber-bag insufflator. He employs this method 
with signal success in " granular ophthalmia, pannus, phlyctenular or 
pustular ophthalmia, chronic granulations, herpes cornem, fascicular 
corneitis, and some ulcers of the cornea." This application produces 
very little pain at the moment, and is not followed by any inflamma- 
tory reaction. 

Tannic acid has limited uses in diseases of the skin. It is an excel- 
lent application, especially in the form of the glycerite, in eczema, im- 
petigo, and intertrigo. The powder dusted on the affected surface is 
serviceable in cases of ulceration of the skin, and promotes the healing 
process in cases of old ulcers. One of the best applications to irritable 
and fissured nipples is glycerite of tannin. 

Chronic otorrhoea and the vulvitis of children are successfully 
treated by application of the glycerite of tannin. The same remedy 
is one of the best injections in gonorrhoea. Solutions of tannic acid of 
various degrees are used in gonorrhoea. Ricord recommends, in obsti- 
nate cases, after the subsidence of acute symptoms, 3 ss of tannic acid 
in | viij of claret wine. This constitutes a serviceable injection in leu- 
corrhcea. Sigmund advises the following in gonorrhoea : Ifr Acidi tan- 
nici, grs. ij — grs. x ; tinct. iodinii, th, v ; aquae, | j. M. Sig. : As 
an injection. An infusion or decoction of galls, of oak-bark, of witch- 
hazel (hamamelis), of geranium, of alum-root, or other remedies of the 
list at the head of this article, may be advantageously used in cervicitis, 
vaginitis, purulent discharges from the vagina. In these affections 
the glycerite of tannin, and, much better, the powdered tannin, may 
be freely applied to the vaginal canal. The author knows of no more 
effective application in these maladies than tannin and iodoform, or iodo- 
tannin, applied in the dry way, well packed around the cervix uteri. 

A serviceable ointment for haemorrhoids is the following prescrip- 
tion of Oesterlen : $ Pulv. gallse, 3j ; pulv. opii, grs. x ; ung. plumbi 
subacetat., 3ij ; ung. simplicis, 3 j. M. Sig. : Ointment for haemor- 
rhoids. Y ox prolapsus ani in children the glycerite of tannin, pow- 
dered tannin, or a decoction of the vegetable astringents considered in 
this article, may be used, the mucous membrane being first carefully 
cleansed and then brushed over with the medicament. Ulcers of the 
rectum and anus, fissures of the anus, are very effectively treated by 
the direct application of the powder of tannin, tannin and iodoform, 
or iodo-tannin. The ulcer must be exposed, if necessary, by the use 
of the speculum, and then the powder be thoroughly applied to the 
affected surface. Trousseau strongly recommends a mixture of the 
decoction and the tincture of rhatany as an injection for the cure of 
fissure of the anus, but the applications above advised are neater and 
more effective. 



PYROGALLIC ACID. 325 

Acidum Pyrogallicum. — Pyrogallic Acid. 

Properties. — Gallic acid, subjected to a high temperature, loses 
its water of crystallization and becomes pyrogallic acid. This is a 
white, shining powder, crystalline in structure, without odor, and hav- 
ing a persistent bitter taste. It is soluble in two and a half parts of 
water, and to some extent in alcohol and ether. For exhibition by the 
stomach, the pill-form is best, the excipient being some unoxidizable 
substance, and the coating complete. The dose for internal adminis- 
tration will range from one sixth of a grain to two grains. For topi- 
cal application, solutions are preferred, and they vary in strength from 
one to ten per cent. Solutions can not be kept long, because of chemi- 
cal changes ; exposed to light, the color becomes brownish, and the 
power declines with the loss of oxygen. 

Pyrogallic acid is an active poison, and this property is exhib- 
ited as well when administered by the stomach as when applied to 
an abraded surface on the skin. Caution in its use becomes neces- 
sary, therefore, for several instances of fatal poisoning, and numer- 
ous cases in which the toxic action was stopped by treatment, have 
been reported. 

Pyrogallic acid is an irritant poison, and all the characteristic ac- 
tions of that group of remedies follow its administration in sufficient 
quantity — nausea, vomiting, purging, accompanied by intense gastro- 
enteric inflammation (Besnier). The changes wrought in the blood 
are significant in a high degree. It impairs or destroys the respiratory 
function of the blood by the damage it inflicts on the red corpuscles, 
which are disorganized, the haemoglobin separated. Changes in the 
intima of the blood-vessels, fatty and fibroid degeneration of organs, 
especially of the liver and kidneys, are constant results of its toxic 
activity (Neisser) ; and of these lesions, we find the clearest evidence 
in the changes which take place in the urine, which becomes brown, 
almost black, and by the presence in it of haemoglobin, or the products 
of its decomposition. Decline in temperature, profound anaemia, 
haemorrhages, especially haematuria, are also most clearly significant 
of the toxic action. It need hardly be observed that such dire results 
are toxic, and the quantity of the agent necessary to produce them is 
much beyond ordinary medicinal doses. 

The elimination of pyrogallic acid takes place by the ordinary 
channels, but especially by the kidneys and liver. It is probable that 
the structural changes in the eliminating organs are due to the imme- 
diate contact of the acid as it passes out of the system. 

Therapy. — The use to which pyrogallic acid was first applied, was 
suggested by its therapeutical relationship to chrysarobin. As is now 
well known, chrysarobin, under the designation " Goa-powder," has 
proved to be an efficient remedy for psoriasis and parasitic affections 
of the skin. If pyrogallic acid is not so certain, which may well be 



326 AGENTS INCREASING WASTE. 

doubted, it has great advantages. Both color and irritate or inflame 
the skin, but pyrogallic acid is far less injurious in its local action 
(Jarisch). 

Having very powerful germicide action, pyrogallic acid is an effi- 
cient remedy m pityriasis versicolor, herpes tonsurans, favus, etc., and 
it has also exhibited some curative action in more serious affections, as 
lupus and epithelioma. 

The strength of the solutions used has ranged from one hundredth 
to one tenth per cent. The ointment made in these proportions with 
vaseline or lard — more frequently vaseline — is held to be less effective 
than solutions of the same, which are also more readily applied (Arra- 
gon, Kaposi). 

If the solutions or unguents are too strong, or frictions too forci- 
bly made, violent inflammation may be set up, and permanent injury 
done to the skin. More or less brownish discoloration of the skin is 
an effect of the application, but it is not permanent. The aqueous or 
alcoholic solution of pyrogallic acid can be applied to the affected sur- 
face by means of absorbent cotton, the strength of the solution and 
the duration of the application being regulated by the effect it has on 
the diseased surface. As, however, toxic effects follow if the applica- 
tion is made over too extensive surface, a part of the diseased area 
only should be treated at one time. 

M. Vidal has made the important announcement that the ointment 
of pyrogallic acid is an excellent application to chancroid, especially if 
it tends to slough. A few applications change the character of the 
sore, and soon effect cicatrization. 

In the treatment of ulcers, sloughing phagedena, epithelioma, 
and similar conditions, pyrogallic acid may be mixed with a pow- 
der — kaolin or starch, for example — and then well dusted over the dis- 
eased part. 

Authorities referred to : 

Arragon, Dr. These de Paris (quoted). 

Besnier, Dr. E, Bui Gen. de Therap. for 1884. 

Hamilton, Robert, F. R. C. S. On the Employment of Tannic Acid in some Diseases 
of the Eye and Eyelids. The Practitioner, vol. ii, p. 347. 

Hanbury and Fluckiger. Pharmacographia, pp. 170, 213, 536, et seq. 

Husemann, Drs. August und Theodok. Die Pfanzenstojfe, p. 996, and pp. 1002, 
1006, 1008, et seq. 

Jarisch, Dr. A. Centralblatt fur die gesammte Therapie, vol. i, p. 17, et seq. 

Kaposi, Prof. Dr. Ibid. 

Neisser, Dr. Annuaire de Therap., 1883. 

Pharmacopeia of the Throat Hospital. 

Phillips, Dr. C. D. F. Materia Medica and Therapeutics, p. 520. 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests : Various 
articles on the indigenous remedies mentioned at the head of this article. 



COLCHICUM. 327 

Ringer, Dr. Sidney. On the Glycerine of Tannin. The Practitioner, vol. i, p. 27. 
Ibid., Handbook of Therapeutics. 

Stille Dr Alfred. Treatise on Therapeutics and Materia Medica, fourth edition, 
vol. i, article Vegetable Astringents. 

Terrillon, Dr. Ibid. 

Trousseau et Pidoux. Trait'e de Th'erap. et de Mat. Med., huitieme Edition, vol. i, 
p. 133, et seq., article Medicaments Astringents. 

Vidal, Dr. E. These de Paris (quoted). 

Waldenburg, Prof. Dr. L. Die locale Behandlung der Krankheiten der Athmungs- 
organe, Berlin, 1872, p 237, et seq. 

Waldenburg und Simon. Handbuch der Arzneiverordnungs-Lehre. 

Colchicum. — Meadow saffron. Colchique, Fr.; Zeitlose, Ger. 

Colchici Radix. — Colchicum-root. The corm of Colchicum au- 
tumnale. 

Colchici Semen. — Colchicum-seed. The seed of Colchicum au- 
tumnale. 

Preparations. — 1. Of the root. 

Extractum Colchici Radicis Fluidum. — Fluid extract of colchi- 
cum-root. Dose, v\ ij — ttj, v. 

Yinum Colchici Radicis. — Wine of colchicum-root. Forty parts 
of colchicum-root to one hundred of stronger white wine. Dose, 
v\ v — T\[ xxx. 

Extractum Colchici Radicis. — Acetous extract of colchicum-root. 
Dose, gr. ss — gr. ij. 

2. Of the seed. 

Extractum Colchici Seminis Fluidum. — Fluid extract of colchicum- 
seed. Dose, v\ ij — v\ x. 

Tinctura Colchici. — Tincture of colchicum. Fifteen parts of 
colchicum-seeds to one hundred parts of diluted alcohol. Dose, 
v\ x — 3 j. 

Vinitm Colchici Seminis. — "Wine of colchicum-seed. Fifteen parts 
of the seed to one hundred parts of stronger white wine. Dose, TfL x 

-3j. 

Composition. — Tannic and gallic acids, starch, sugar, gum, a pe- 
culiar alkaloid, colchicina or colchicine. Colchicine is easily con- 
verted (by acids, in long-kept alcoholic preparations) into an iso- 
meric, cystallizable body, colchicein. The amount of the alkaloid 
contained in the root and the seed is said to be not greater than the 
half of one per cent. Colchicine is not crystallizable, but combines 
with acids to form crystallizable salts. The conversion, in any of 
the pharmaceutical preparations, of colchicine into colchicein, does 
not appear to impair the therapeutical activity. That colchicine is 
the active principle, is proved by the fact that the physiological 
effects of this alkaloid are the same as those of the crude drug 
(Husemann). 



328 AGENTS INCREASING WASTE. 

Antagonists and Incompatibles. — Tannic acid, by forming an 
insoluble tannate with the alkaloid, retards but does not prevent its 
absorption. When a lethal quantity has been taken, emetics and pur- 
gatives are required, and demulcents may be freely administered. 
Opium and the alcoholic substances antagonize the depression of the 
heart's action. 

Syneegists. — Such alkaloids as produce gastro-intestinal irritation 
and depress the action of the heart, e. g., veratrine, aconitine, etc., are 
synergistic. Therapeutically considered, emetics, purgatives, alkalies, 
promote the activity of colchicum. 

Physiological Actions. — Colchicum imparts its virtues to water, 
alcohol, and ether. It has a bitter taste, and excites the flow of saliva. 
In small doses it increases the mucous and glandular secretion of the 
stomach and intestines, and probably also of the liver, kidneys, and 
skin. If the dose be large but still medicinal, colchicum produces a 
feeling of epigastric heat, nausea, and vomiting, depression of the cir- 
culation, muscular feebleness, headache. It frequently purges, pro- 
ducing copious watery stools, and is generally held to increase the 
discharge of biliary matters. It increases the flow of urine, of the 
solid constituents (urea, uric acid, etc.), as well as of the water, and 
promotes the cutaneous transpiration. In toxic doses colchicum pro- 
duces all of the local as well as the systemic effects of an irritant 
poison, viz. : acute abdominal pain, profuse watery and choleriform 
discharges, suppression of urine, feeble pulse, cold sweat, coldness of 
the extremities. The intellect remains unaffected until carbonic-acid 
poisoning supervenes. The muscular cramps which have been occa- 
sionally observed are probably due to the great loss of fluid from 
the system. When colchicine is injected subcutaneously, gastro-intes- 
tinal inflammation is produced, showing that it has a selective action 
on this tissue. 

This view of the action of colchicum has been fully confirmed by 
Dr. Roy. The strongly accentuated impression on the mucosa of the 
intestine is due, he affirms, to its elimination by this membrane and 
the profuse watery discharge as a transudation. 

Theeapy. — Colchicum is indicated when rapid wasting of tissue 
and prompt elimination of the products of waste are required. Its use 
at the present time is almost entirely restricted to the treatment of 
goat in its various manifestations. It relieves the pain, diminishes the 
swelling, and shortens the duration of an attack of acute gout. In 
order to accomplish these results, it is not necessary that the more 
harsh and violent physiological effects of the drug be produced. Suf- 
ficient quantity of colchicum should be given to increase secretion from 
the skin, the intestinal mucous membrane, and the kidneys, but nausea 
and vomiting should be avoided. Combination with an alkali increases 
the therapeutical effect of colchicum : $ Spts. amnionic aromat,, 3 xiij; 



COLCHICUM. 329 

vmi seminis colchici, 3 iij. M. Sig. : A teaspoonful every three hours, 
until some physiological effect is produced. The following is a formula 
used at the London Hospital for gout : I£ Tinct. colchici seminis, v\ xx ; 
potassii bicarbonat., grs. x ; aquae pimentae, § j. M. Sig. : A draught. 
The following modification of Scudamore's prescription is in use at 
University College Hospital : I£ Tinct. colchici seminis, v\ xv ; mag- 
nesii carb., gr. vj ; magnesii sulph., grs. xxx ; aquae menth. pip. ad 
§ j. M. Sig. : A draught. After the more acute symptoms of the 
gouty attack have subsided, the following was recommended by Sir 
Henry Halford : £> Ext. colchici acet., gr. vj ; pulv. opii et ipecac, comp., 
ext. colocynth. comp., aa gr. xij. M. Ft. pil. no. xij. Sig. : One pill 
night and morning. The efficiency of colchicum is increased by com- 
bination with digitalis : t> Ext. colchici acet., gr. x ; pulv. digitalis, 
ext. colocynth. comp., aa 3j. M. Ft. pil. no. xx. Sig. : One pill 
tioice or thrice a day. 

The active principle, colchicine, is, there is reason to believe, more 
successful in gout than any of the preparations of the crude drug. P> 
Colchicinae, gr. j ; ext. colocynth. comp., 3 ss ; quininae sulph., 3 iij. 
M. Ft. pil. no. lx. Sig. : One every four hours. 

In the so-called rheumatic gout, colchicum with alkalies is extreme- 
ly serviceable. Attacks, without decided pain and inflammation, of 
soreness of joints, which have been the seat of gouty attacks, or about 
which nodosities have been deposited, are relieved by colchicum. 

Constipation, hepatic congestion, and headache, due to torpor of 
the portal circulation, occurring in gouty subjects, are quickly relieved 
by a combination of colchicum and saline purgatives. The plethoric 
and overfed without being gouty, suffering from the same group of 
symptoms, are relieved by the same means. Inflammations of internal 
organs occurring in gouty subjects, for example, gouty bronchitis and 
rheumatic pneumonia, are best treated with prescriptions containing 
a preparation of colchicum. The following prescription is recom- 
mended by Greenhow in gouty bronchitis : I> Potassii iodidi, ammonii 
carbonat., aa 3] ; vin. colchici seminis, 3 j ; tinct. scillae, tinct. hyos- 
cyami, aa 3 ij ; aquae c amphorae q. s. ad § iij. M. Sig. : A table- 
spoonfid three times a day. 

Although colchicum is still advocated by some authorities in acute 
rheumatism, the general professional experience is against its use. In 
chronic rheumatism, when the joint changes are allied in nature to 
those which take place in gout, it is unquestionably serviceable. Neu- 
ralgia occurring in gouty and, rheumatic constitutions is often relieved 
by colchicum. The indications for its use are plethora, constipation, 
and deficient excretion of the liver, kidneys, and skin. Colchicum re- 
lieves in such cases, by setting up an eliminative process. In hepatic 
dropsy and cardiac dropsy, when the patient is vigorous, the gastro- 
intestinal tract free from inflammatory mischief, colchicum may be 



330 AGENTS INCREASING WASTE. 

used with advantage as a hydragogue : I£ Elaterii, gr. j ; spts. etheris 
nitrosi, 3 ij ; tinct. scillse, tinct. colchici, aa | ss ; syrup, simplicis, | j. 
M. Sig. : ^1 teaspoonful three or four times a day. The following 
combination is an excellent diuretic in dropsy : ^ Yini seminis col- 
chici, § ss ; sol. ammonii acetat., § ijss ; inf. petroselin, f v. M. Sig. : 
A tablespoonful every four hours. This prescription is well adapted 
to dropsy following scarlatina. 

Colchicum is a serviceable remedy in certain cerebral disorders. 
Thus, it may be used in acute cerebral congestion in plethoric subjects, 
in urcemic intoxication, in hypochondriasis, especially when due to 
deficient elimination (uric acid, oxalate of lime, etc.). 

The wine of colchicum-seed has frequently succeeded in curing 
gonorrhoea, and by Brodie a nightly dose of thirty minims was given 
for the relief of chordee. In the treatment of gonorrhoea, the follow- 
ing may be used : t> Vini colchici seminis, § ss ; sol. potassii citratis, 
1 vjss ; tinct. opii deod., 3 ij. M. Sig. : A tablespoonful three or 
four times a day in gonorrhoea. 

Authorities referred to : 

Brodie, Sir Benjamin. Works by Mr. Hawkins, Diseases of Urinary Organs, 
vol. ii. 

Caspar, Johann Lttdwig. Practisches Handbuch der gerichtlichen Median. Neu 
bearbeitet und vermehrt von Dr. Carl Liman, Berlin, 1871, p. 5*70. 

Fuller, Dr. William Henry. On Rheumatism, Rheumatic Gout, etc., 1874. 

Greenhow, Dr. E. Headlam. Chronic Bronchitis, etc. 

Gubler, Dr. Adolphe. Commentaires du Codex Medicamentarius, etc., article Col- 
chique. 

Hanbury and Fltjckiger. Pharmacographia, p. 636. 

Hammond, Dr. W. A. The Amerian Journal of the Medical Sciences, January, 1859, 
p. 278. 

Husemann, Drs. Theo. and Aug. Die Pflanzenstoffe, p. 493, article Colchicin. 

Roy, Dr. Ch. Archives de Physiologie, normale et pathologique. New series, vol. v, 
p. 656. 

Sarsaparilla. — Sarsaparilla. Root of Smilax officinalis and other 
species of smilax. Separeille, Fr. ; Sarsaparillwurzel, Ger. 

Decoctum /Sarsaparilla? Compositum. — Compound decoction of sar- 
saparilla. (Sarsaparilla, sassafras-root, guaiacum-wood, licorice-root, 
mezereon.) Dose, § j — § iv. 

Extractum Sarsaparillm Fluidum. — Fluid extract of sarsaparilla. 
Dose, 3 j — 1 ss. 

Syrupus Sarsaparillm Compositus. — Sirup of sarsaparilla. (Sarsa- 
parilla, guaiacum-wood, rose, senna, licorice-root, essential oils.) Dose, 
3 j— 1 ss. 

Extractum Sarsaparillm Compositum Fluidum. — Compound fluid 
extract of sarsaparilla. (Sarsaparilla, licorice-root, sassafras, meze- 
reon.) Dose, 3 ss — 3 ij. 



SARSAPARILLA. 331 

Composition — An alkaloid, parilline, or smilacine, an essential oil, 
starch, resin, oxalate of lime, and extractive matters. From parilline, 
by the action of dilute sulphuric acid, is obtained parigenine, a distinct 
alkaloid. 

Antagonists and Incompatibles. — Alkalies favor the decomposi- 
tion of the decoction and fluid extracts. As there is much starch pres- 
ent in the drug, free iodine should not be prescribed with the official 
preparations. 

Synergists. — Iodine, mercury, and other so-called alteratives, in- 
crease the therapeutical activity of sarsaparilla. Warm clothing in- 
creases the action on the skin ; diluents favor increased urinary dis- 
charge. 

Physiological Actions. — Much discrepancy obtains in the opin- 
ions which have been emitted in respect to the physiological actions 
of sarsaparilla. Surgeons generally hold to its therapeutical powers ; 
physicians are skeptical. The physiological experiments which have 
been made, both with the preparations of the crude drug and with the 
alkaloid, have yielded negative results. Palotta's experiments, made 
with the alkaloid which he had discovered so long ago as 1825, indicate 
that eight grains of the alkaloid produce gastric disturbance, vomiting, 
slowing of the pulse, depression, faintness, and sweating. These re- 
sults have since been in part confirmed by Cullerier. Boecker, how- 
ever, making more systematic examination in accordance with modern 
methods, finds that sarsaparilla is devoid of physiological activity and 
of therapeutical power (Husemann). 

Therapy. — From the point of view of the physiological experi- 
ments it is not difficult to understand the modern incredulity in regard 
to the curative power of sarsaparilla. The difficulty of distinguishing 
between the post hoc and the propter hoc serves to account for the 
belief still held in some quarters, that this drug is an alterative. Pop- 
ularly, sarsaparilla is supposed to have extraordinary powers as a 
" blood-purifier," and its large use at the present time arises from this 
belief. 

Almost the only use of sarsaparilla at the present time is in the 
treatment of syphilis. It is, of course, not adapted to the primary or 
to the secondary forms. The experience in its favor, even of those 
most confident of its powers, restricts its use to the tertiary form in 
debilitated subjects, who have been broken down by the combined in- 
fluence of syphilis, mercurialism, and iodism. It has been further dem- 
onstrated that the best effects have been obtained by the use of large 
doses of the compound decoction (Allbutt). As the compound decoc- 
tion contains guaiac and mezereon, it is difficult to assign the exact 
share of the sarsaparilla in the result. Furthermore, as a pint or more 
of the compound decoction must be taken in the twenty-four hours, 
these large draughts of a warm liquid are not without influence on the 



332 AGENTS INCREASING WASTE. 

functions of the skin and kidneys. It is extremely questionable 
whether sarsaparilla has any therapeutic power ; it is not at all equal 
us an alterative to some of the remedies indigenous in the United 
States, to be considered hereafter. 

The compound fluid extract, the compound decoction, and the 
compound sirup of sarsaparilla, are frequently used as vehicles for 
iodide of potassium and for the bichloride of mercury in secondary 
and tertiary syphilis. 

Scrofula, chronic abscesses, necrosis of bones, old ulcers, and stru- 
mous cutaneous affections, are diseases in which sarsaparilla is sup- 
posed to be efficacious. It is more used as an adjunct to more active 
remedies than depended on alone. 

Authorities referred to : 

Allbutt, Dr. Clifford. TJie Practitioner, 1870, vol. i. 

Gcbler, Dr. Adolphe. Commentaires T/ierap. du Codex Medicamentwius, p. 304. 

Hanbury and Fluckiger. Pharmacographia, p. 636, et seq. 

Husemann, Drs. Aug. und Theodor. Die Pflanzenstoffe, p. 1040. 

Guaiacum. — Guaiac. Gayac, Fr. ; Franzosenholz, Ger. 

Guaiaci Lignum. — Guaiacum-wood. The heart- wood of Guaiacum 
officinale. 

Guiaci Resina. — Guaiac. A peculiar resin obtained from Guaia- 
cum officinale. 

Tinctura Guaiaci. — Tincture of guaiac. (Guaiac, 20 parts ; alco- 
hol, to 100 parts.) Dose, 3 ss — 3 ij. 

Tinctura Guaici Ammoniata. — Ammoniated tincture of guaiac. 
(Guaiac, 20 parts ; aromat. spirit of ammonia, to 100 parts.) Dose, 
3 ss— 3 ij. 

Composition. — The only constituent of interest in the wood is the 
resin. Guaiac has a complex chemical composition. It contains gua- 
iaconic acid (seventy per cent), guaiarec acid, guaiac beta-resin, guaia- 
cic acid, guaiac yellow, gum, etc. 

Antagonists and Incompatibles. — Spirits of nitrous ether and the 
mineral acids are incompatible. 

Synergists. — Agents which promote cutaneous activity are syner- 
gistic. The action of guaiac is much aided by external warmth and 
warm diluent drinks. 

Physiological Effects. — Guaiac has a very acid and pungent 
taste. It excites an abundant flow of saliva. In the stomach it cre- 
ates a sensation of warmth and burning, increases the secretions of the 
gastro-intestinal canal, accelerates the action of the heart, promotes 
diaphoresis, and favors the production and excretion of bronchial mu- 
cus. In large doses it deranges digestion and causes gastric catarrh, 
and in excessive doses the series of symptoms produced by the irritant 
poisons, vomiting, purging, cramps, headache, giddiness, etc. 



STILLINGIA. 333 

Therapy. — Formerly guaiac was in great repute as a remedy for 
constitutional syphilis. The decoction was drunk in large quantity, a 
very spare diet was enjoined, and the diaphoretic action of the rem- 
edy was aided by external warmth. Doubtless many cases were bene- 
fited by this mode of treatment, but the result was probably less due 
to guaiac per se than to the regimen. 

Its present use as an anti-syphilitic remedy is confined to the prep- 
arations of sarsaparilla, in which it enters as a constituent. 

Recent clinical experience has shown that guaiac is a capital rem- 
edy in tonsillitis. Given in a half-drachm dose (tincture) every four 
hours, it appears to abate the inflammation and to cut short the dis- 
ease in a remarkable manner. It is a very acrid and disagreeable rem- 
edy, and should be given in emulsion, with mucilage or yolk of egg. 

Guaiac is a useful remedy in dysmenorrhea, when the pain is due 
to rheumatism or neuralgia, and is of course not adapted to those 
cases in which there is narrowing of the cervical canal. 

Lastly, guaiac is used with varying degrees of success in chronic 
gout, chronic rheumatism, lumbago, sciatica, gouty bronchitis, etc. As 
we have so many more efficient and pleasant remedies for these dis- 
eases, it will rarely be necessary to resort to guaiac. 

Authorities referred to : 

Carter, Mr. Tlie Practitioner, vol. iv, p. 190. 

Fltjckiger and Hanburt. Pharmacograpliia, p. 92, et seg. 

Husemann, Drs. Aug. und Theo. Die Pjlanzenstoffe, p. 712. 

Stille, Dr. A. Therapeutics and Materia Medica, fourth edition, vol. ii, p. 594. 

Stillingia. — Root of Stillingia sylvatica. Yaw-root, queen's root. 

Extractum /Stillingiw Fluidum. — Fluid extract of stillingia. Dose, 
m x— 3 j. 

(The above is the only preparation recognized by the United States 
Pharmacopoeia. A tincture may be made of two ounces of the bruised 
root to a pint of diluted alcohol, of which the dose is 3 ss — 3 ij. A 
decoction may be made as follows : one ounce of the bruised root to 
two pints of water, boiled down to one pint, of which the dose is § ss 
— 5 ij- All the preparations should be made of the fresh root, as the 
activity of the drug is diminished by drying.) 

Composition. — The plant yields on incision a milky juice, which 
appears to possess the medicinal properties of the drug. The so-called 
stillingin of the eclectics is not the active principle, but an extract. 
The active principle has not yet been isolated. 

Physiological Effects. — The juice of the plant has an acrid, pun- 
gent taste, leaving a persistent after-taste of great activity. It excites 
an abundant flow of saliva. In the stomach a feeling of warmth fol- 
lows its use, and the secretions of the organ are increased in amount. 
In full doses it excites nausea and vomiting, epigastric pain, and an 



334: AGENTS INCREASING WASTE. 

acrid, burning sensation in the fauces. It increases the secretions of 
the intestinal canal, notably of the liver, and, in full doses, purges, the 
faeces having the appearance of the so-called "bilious stools." In- 
creased action of the heart follows the introduction of the active prin- 
ciple into the circulation, and the skin becomes warm and moist. The 
bronchial mucous membrane exhales a larger quantity of mucus, and 
the kidneys become more active, excreting an increased quantity of wa- 
ter and solids. It may, therefore, with propriety be grouped with the 
so-called alteratives. 

Therapy. — Stillingia is certainly a very valuable remedy. It has 
long had a local reputation in the Southern Atlantic States as an al- 
terative. 

In habitual constipation, due to deficient secretion of the intestinal 
mucous membrane, it may be used with advantage. The torpidity of 
the liver and jaundice, which follow attacks of intermittent fever, are 
removed by stillingia. This agent also renders important service in 
the first stage of cirrhosis, and in ascites due to the hepatic changes. 
Hemorrhoids, when produced by obstructive difficulty in the liver, 
may be removed temporarily, and, if due to constipation, may be re- 
moved permanently, by stillingia. 

In habitual constipation the following formula is useful : ^ Ext. 
stillingiae fl., 3 v ; tinct. belladonna? ; tinct. nucis vom. ; tinct. physostig- 
matis, aa 3 j. M. Sig. : Twenty drops, in water, three times a day be- 
fore meals. When the biliary secretion is deficient, the following : IjS, 
Ext. stillingia? fl., 3 v ; tinct. aloes, 3 ij ; tinct. nucis vom., 3 j. M. 
Sig. : Twenty drops, in water, three times a day. 

Stillingia has long been in popular repute as an alterative, and em- 
ployed in domestic practice as a remedy for scrofula in its various 
forms. The success which has attended its employment in some de- 
gree justifies the high encomiums which have been bestowed on it. 
It is very serviceable in children who present the following symptoms : 
enlarged cervical glands, muco-purulent discharge from the nose, icith 
excoriations of the surrounding integument, a pasty complexion, ca- 
pricious and unnatural appetite, tumid abdomen, ichitish and pasty 
stools ; dull-red, soft, and tubercidar eruption on the skin, ulcerating 
and furnishing a large quantity of unhealthy pus. The steady use 
of stillingia, combined with suitable hygienic means, will accomplish 
important relief in such cases. 

The most satisfactory results have been obtained from the use of 
stillingia in syphilitic affections. It is applicable to the same condi- 
tions under which the preparations of sarsaparilla are now used, viz., 
in chronic cases of the secondary and tertiary form, the patients hav- 
ing been broken down by the long-continued use of mercurials and 
iodides. Repeated observation of cases in which it was used as the 
sole agent has satisfied me of its curative value. It differs from the 



SANGUINARIA. 335 

compound decoction of sarsaparilla in this, that its effect is distinctive, 
and is not due to the use merely of a large quantity of fluid. The 
eminent Dr. Porcher, of South Carolina, thus expresses himself with 
regard to the use of stillingia in syphilitic affections : " I have em- 
ployed the decoction of the root of this plant as an alterative in syphi- 
litic sores, occurring in patients in the City Hospital, Charleston, the 
spread of which nothing else could arrest. It proved completely satis- 
factory. Phagedenic chancres were rapidly cured under its use. A 
strong decoction was given three times a day, with four drops of nitric 
acid to each dose." 

A strong infusion or decoction of stillingia is said to be effective 
in preventing the development of a paroxysm of ague, if taken before or 
just as the chill is beginning. It is reported that profuse diaphoresis 
is produced and the impending attack is averted. The fluid extract 
of stillingia may be given in combination with quinine or arsenic in 
intermittents. 

Authorities referred to : 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, Charles- 
ton, 1869, p. 146. 

Sanguinaria. — Blood-root. The rhizoma of Sanguinaria Cana- 
densis Linne (Nat. Ord. Papaveracece), collected in autumn. (U. S. P.) 

Tinctura Sanguinarice. — Tincture of sanguinaria. Dose, v\ v — 
3 ss. 

Acetum Sanguinarim. — Yinegar of sanguinaria (sanguinaria, 10 
parts ; diluted acetic acid, sufficient to make 100 parts). Dose, tt[ v — 
3 ss. 

JExtraetum Sanguinarice Fluidum. — Fluid extract of sanguinaria. 
Dose, iTj, ij — Tij, xx. 

Composition. — Sanguinaria contains an alkaloid, sanguinarine, 
which appears to be identical with the chelerythrine of Probst. San- 
guinarine is a white, pearly substance of an acrid taste, very sparingly 
soluble in water, soluble in ether, and very soluble in alcohol. With 
the acids it forms salts soluble in water, all of which have some shade 
of red, crimson, or scarlet, and form beautiful red solutions. Another 
alkaloid, named porphyroxine (sanguinaria-porphyroxin — Husemann), 
has been found by Riegel. Besides these alkaloids, sanguinaria con- 
tains a peculiar acid, chelidonic, and another has been announced, for 
which the name sanguinarinie acid has been proposed, but this latter 
acid has been shown to be a mixture of malic and citric acids. The 
alkaloids exist in the root in combination with these acids — the most- 
important compound being the chelidonate of sanguinarine. Besides 
the foregoing, blood-root contains the following unimportant constitu- 
ents : resin, gum, extractive, albumen, sugar, etc. 



336 AGENTS INCREASING WASTE. 

Antagonists axd Incompatibles. — Alkalies, tannic and gallic 
acids, and most of the metallic salts, are chemically incompatible with 
the preparations of blood-root. The local irritant action of the drug 
and the depression of the circulation which it causes are antagonized 
by opium, by amyl nitrite, by atropine, etc. 

Syneegists. — The mineral and vegetable emetics, the so-called 
alteratives of the vegetable kingdom, and the mineral salts, considered 
from the therapeutical point of view, promote the physiological and 
therapeutical effects of sanguinaria. 

Physiological Effects. — Sanguinaria has a bitter, acrid taste, 
which persists for a long time. When swallowed, it leaves a sense of 
constriction and acridity in the throat. It excites a feeling of heat in 
the stomach, and stimulates secretion of the mucous membrane. If the 
quantity taken is insufficient to produce nausea, the action of the heart 
is increased, and a subjective sensation of warmth is experienced 
throughout the system. In considerable doses sanguinaria is an active 
emetic, producing much nausea and depression, and slowing the action 
of the heart. It is very irritating to the mucous membrane. Snuffed 
up the nose, it produces violent sneezing. In large doses it inflames 
the stomach, producing intense burning, with thirst, great prostration, 
dimness of vision, vertigo, and collapse. 

The alkaloid, sanguiyiarine, manifests all the physiological capa- 
bilities of the drug. It has an intensely bitter, acrid taste. In small 
doses (one twelfth to one eighth of a grain) it simply increases secre- 
tion of the gastro-intestinal mucous membrane ; in doses of one sixth 
to one fourth of a grain it causes depressing nausea and sometimes 
vomiting. In large doses it produces, in addition to the gastric symp- 
toms mentioned above, slowing and irregularity of the pulse, cold 
sweats, cold extremities, vertigo, dilated pupils, anxiety, etc. 

Applied to fungous granulations, sanguinaria has considerable es- 
charotic power. 

The sketch above given of the physiological actions of sanguinaria, 
which embodies the results of the author's investigations and clinical 
studies, requires no special modification. The recent elaborate and 
most thorough research of Dr. Robert Meade Smith confirms the 
author's account. The reader who wishes to exhaust the subject will 
find that nothing has been omitted by Dr. Smith. 

Theeapy. — In atonic dyspepsia from two to five drops of the tinc- 
ture, or the one twelfth of a grain of sanguinarine, may be used with 
advantage. It promotes secretion, and increases the appetite. There 
seems no doubt, according to the author's observation, that sanguinaria 
promotes the hepatic and intestinal secretions. It is, therefore, a ser- 
viceable remedy in duodenal catarrh, and secondary catarrh of the 
biliary ducts with jaundice. 

Its most important therapeutical effects are witnessed in diseases of 



SANGUINARIA. 337 

the respiratory organs. Chronic nasal catarrh is successfully treated 
by the internal use of the tincture (ten drops ter die), or of the alkaloid 
(one fifteenth of a grain ter die), and the local application of the pow- 
der, in small quantity, applied by an insufflator to the Schneiderian 
mucous membrane. In acute bronchitis (catarrh), after the subsidence 
of the more acute symptoms, it is a serviceable expectorant. It may 
be combined with other expectorants and alterants : 3 Tinct. sangui- 
nariae, 3 j ; tinct. lobelise, 3 j ; vini ipecac, 3 ij ; syrup, tolutan., 1 ss. 
M. Sig. : A teaspoonful every three hours as an expectorant. In 
humid asthma the following combination is extremely serviceable : ^ 
Tinct. sanguinarise, 3 j ; tinct. lobelise, 3 j ; ammonii iodidi, 3 j ; syrup, 
tolutan., 3 vj. M. Sig. : A teaspoon fid every two, three, or four hours. 
In spasmodic asthma the same prescription is occasionally very effect- 
ual, but the author is unable to indicate the precise condition under 
which it is most useful. 

Sanguinaria has been proposed as an emetic in croup. It is, how- 
ever, too uncertain in action, and too harsh, to justify its use when 
there are so much more eligible remedies at hand. 

The emmenagogue properties of sanguinaria seem well established. 
It is indicated when amenorrhoea is functional in character, when 
there is an absence of plethora, and when no malformation exists. It 
may be advantageously combined with aloes, provided there is no con- 
traindication to the use of the latter. 1^ Tinct. sanguinariae, 3 ij ; 
tinct. aloes, 5 ss ; tinct. nucis vom., 3 ij. M. Sig. : Tioenty drops two 
or three times a day, in amenorrhoea of anaemia, or chlorosis. Or the 
following : 3 Sanguinarinae, grs. ij ; ext. aloes, grs. x ; ferri redacti, 
3j. M. Ft. pil. no. xx. Sig. : One pill three times a day. 

Sanguinaria has decided aphrodisiac properties. When there are 
relaxation of the genital organs, diurnal losses, inaptitude (from irrita- 
bility) for coitus, sanguinarine may be given as follows : I? Ergotin 
(aq. ex.), 3j ; sanguinarinae, grs. ij. M. Ft. pil. no. xx. Sig. : One, 
three times a day. As stillingia appears to have similar properties as 
an aphrodisiac, the following combination will prove useful : I£ Tinct. 
sanguinariae, 3 iij ; ext. stillingiae fl., 3 v. M. Sig. : Fifteen to twenty 
drops, in water, three times a day. 

As an alterant in chronic syphilitic and strumous affections, san- 
guinarine may be used in the same class of cases as sarsaparilla, guaiac, 
and stillingia. It is an important addition to a decoction of woods in- 
digenous to our soil, used as a substitute for the more expensive and 
really less efficient foreign drugs of the same group. 

Local Applications. — Sanguinaria, having feeble escharotic prop- 
erty, is used as a local application to repress exuberant granulations, 
and to ill-conditioned ulcers to change their character. Several cases 
have been reported, indicating the power of sanguinaria to repress the 
growth and destroy nasal polypi. 
23 



338 AGENTS INCREASING WASTE. 

A decoction of sanguinaria is a useful gargle in the sore-throat 
of scarlatina. 

Authorities referred to : 

Husemann, Drs. Aug. und Theo. Die Pflanzenstoffe, p. 199. 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 31, 
etseq. 

Phillips, Dr. C. D. F. Materia Medica and Therapeutics, London, 1874, p. 143. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition, vol. ii, p. 454. 

Smith, Dr. Robert Meade. The Physiological Action of Sanguinarina. The Am. 
Jour. Med. Scl, October, 1876, p. 346, et seq. 

Xanthoxylum. — Prickly ash. The bark of Xanthoxylum fraxi- 
neum Willdenow and of JC. carolinianum Lambert (Nat. Ord. JRuta- 
ceoz, Xanthoxylece). 

Extraction Xanthoxyli Fluidum. — Fluid extract of xanthoxylum. 
Dose, in, x — 3 j. 

A decoction may be made by boiling an ounce of the bark in a 
quart of water down to one pint, and of this one to two ounces may 
be used every four hours. A tincture may also be prepared with two 
ounces of the root to a pint of diluted alcohol, of which the dose would 
be 3 ss — 3 ij. The official fluid extract is more frequently in use; the 
dose of this is in xv — 3 ij. 

Composition. — Xanthoxylum contains a neutral crystallizable prin- 
ciple, which is known as xanthoxylin, and is said to be identical with 
xanthopicrite, and the latter has been shown to be berberine. Besides 
this important constituent, a volatile and a fixed oil, resin, gum, etc., 
are contained in it. 

Physiological Actions. — The taste of xanthoxylum is at first 
sweetish, and somewhat aromatic, but considerable bitterness is soon 
developed, followed by acridity, which remains long in the fauces. It 
has remarkable sialagogue property, and the increased flow of saliva 
occurs from the systemic effects, as well as from the local impression 
on the mucous membrane of the mouth. In the stomach it excites a 
sensation of warmth, and increases secretion from the stomach and in- 
testinal mucous membrane. It is in a high degree probable that just 
as its presence in the mouth causes salivation, so its presence in the 
intestinal canal determines the flow of gastric, duodenal, hepatic, and 
pancreatic secretion. The action of the heart is increased by xan- 
thoxylin, the arterial tension rises, the capillary circulation becomes 
more energetic, and the sweat-glands are made to pour forth a more 
abundant secretion. Corresponding effects are produced in the kid- 
neys, and increased flow of urine follows its administration. 

Therapy. — Xanthoxylum is a domestic remedy for toothache. The 
bark, chewed, has a popular reputation for paralysis of the tongue. A 
decoction of the bark is an efficient local application to the throat when, 



FRAXINUS AMERICANA. 339 

in cases of chronic pharyngitis , there is dryness of the mucous mem- 
brane. From ten to thirty minims of the fluid extract, or a half to one 
drachm of the tincture^ ter in die, is a successful remedy for an ex- 
tremely obstinate affection, namely, chronic pharyngitis — the mucus 
adhering in large, thin, dry scales, and the mucous membrane being 
glossy, shining, glazed, and dry. 

The active principle (xanthoxylin) is a useful stomachic tonic in 
atonic dyspepsia. When, however, in stomach, intestinal, or hepatic 
disorders the object is to promote secretion, the preparations of xan- 
thoxylum must be used. Jaundice due to catarrh of the bile-ducts, and 
that form of jaundice produced by acute malarial poisoning, are con- 
ditions in which xanthoxylum is distinctly remedial. Constipation, 
due to deficient secretion, is also removed by this agent. 

Xanthoxylum has long had a deserved reputation in the treatment 
of chronic rheumatism. It is adapted to muscular rheumatism, myal- 
gia, and such local muscular disorders as torticollis (recent cases), lum- 
bago, etc. It may be used with advantage, locally, in these affec- 
tions. The curative power which it possesses in chronic rheumatism 
is doubtless due to its eliminant action on the mucous and cutaneous 
surfaces. 

Xanthoxylum is a remedy for constitutional syphilis of equal merit 
with guaiac, mezereon, stillingia, etc., and is greatly more effective 
than sarsaparilla. 

Decoction of xanthoxylum has been used with success in the treat- 
ment of dropsy. 

Fraxinus Americana. — The inner bark of the root. (Not official.) 

Preparation. — Vinum Fraxini. The inner bark of the root col- 
lected in November, eight ounces ; stronger white wine, or sherry, 
two pints. The root-bark should be macerated in the wine three or 
four days ; after percolation, to every 25 parts there should be added 
2 parts of glycerin and 1 part of alcohol. The dose of the wine thus 
prepared is a teaspoonful or two, three times a day, before meals. 

Actions and Uses. — There has been no adequate study of the 
physiological actions of fraxinus. Its employment is, thus far, merely 
empirical. We owe to Dr. Charles P. Turner, of Philadelphia, the 
knowledge now in our possession regarding its therapeutical powers. 
It belongs to the group of alterative medicines, if we may still use this 
rather obsolete term. Administered in certain diseases, it modifies the 
local morbid process, or cures it without any recognizable disturbance 
of the functions. The chief use of it thus far has been in the treat- 
ment of certain uterine disorders. Dr. Turner has found it to have a 
curative action in chronic metritis, and in the disorders consequent on 
this condition of the uterus. In the various forms of dysmenorrhoea, 
especially the congestive variety, it has proved to be very effective. 
Lest disappointment may be experienced from its use, Dr. Turner 



340 ANTISEPTICS. 

assures us that the administration of the wine must be kept up for 
several weeks or months. When administered for dysmenorrhea, it 
should be taken diligently in the interval, and, when given for metri- 
tis, it should be taken assiduously for several months. How much is 
due to time, and how much to the remedy, has not been shown. 
Authorities referred to : 

Husemann, Drs. Aug. und Theo. Die Pflanzenstoffe, pp. 80, 7 17, 1108. 
Porcher, Dr. F. Peyre. Resources of the Southern Fields and Forests, p. 161. 



REMEDIES, USED TO DESTROY MICROBES OR MOR- 
BIFIC GERMS, AND TO PREVENT OR ARREST 
SEPTIC PROCESSES {ANTISEPTICS, OR GERMI 

CIDES). 

ANTISEPTICS. 

Those remedies are entitled antiseptic which are employed to ar- 
rest fermentative processes. It is now generally admitted that every 
kind of fermentation is correlative of the growth and multiplication 
of a living organism. In various diseases, microzymes, vibrio, bac- 
teria, either stand in a causative relation to the morbid process, or 
are necessary to its evolution and development. 

To illustrate the commanding importance of pathogenic organ- 
isms in modern pathology, it is only necessary to mention a few of 
the more noteworthy discoveries in the new science of bacteriology — 
for example, the spirochaete plicatillis of relapsing fever, the bacil- 
lus of tubercle, the coccus of pneumonia, the comma bacillus of chol- 
era, etc. The mere finding of minute organisms does not suffice to 
prove that their presence is anything more than accidental. To dem- 
onstrate a causative relation, cultures of the organism, and afterward 
successful inoculations, are requisite. 

Very admirable practical results have followed the discovery of 
the alkaloid-like ptomaines in the intestinal canal. Fermentative 
processes set up by germs introduced from without produce these 
substances when the local conditions are favorable. The formation 
of ptomaines, and of such actively poisonous substances as tyrotoxi- 
con, correspond to or imitate methods by which the active principles 
of plants are produced. Increasing experiences, and the accurate 
scientific methods now applied to the whole question, have demon- 
strated that various maladies — some supposed to be constitutional 
in character — are due to these poisons, which, when formed, diffuse 
into the blood, setting up the morbid process characteristic of each 
agent. 



OXYGEN. 341 

The remedies of this group — antiseptics — have the power, when 
brought into contact with the minute organisms or disease-germs men- 
tioned above, to destroy their vitality, and to arrest the fermentation 
process, or zymosis, which they either initiate or promote. There is a 
distinct relation between the antiseptic and antipyretic properties of 
various members of this group, and they have the power to depress 
temperature in the same ratio that they are active in destroying dis- 
ease ferments and germs. Some of these remedies, e. g., quinine, sul- 
phurous acid, the sulphites," etc., have already been discussed in Part 
II. Under this head there remain for consideration several important 
agents whose applications are distinctly antiseptic. 

Oxygenium .— Oxygen. Oxygbie, Fr. ; Sauerstoff, Ger. (Not 
official.) 

Preparation. — The most convenient mode of preparing oxygen 
for medical purposes is to heat in a gun-barrel-shaped brass or iron 
retort a mixture composed of five parts of chlorate of potassium and 
one part of binoxide of manganese. When heated to dull red, the 
chlorate yields up its oxygen, being reduced to chloride. The gas may 
be most conveniently collected over water, which dissolves but little 
of the oxygen, but takes up all the chlorine that may be accidentally 
present. 

It is a permanent, elastic gas, inodorous, without taste, incom- 
bustible, but uniting with bodies in a state of combustion. It 
is very slightly soluble in water at the ordinary temperature and 
pressure. 

Dose. — The quantity of oxygen which may be inhaled, in the or- 
dinary medicinal applications of this gas, ranges from one to five gal- 
lons. The simplest apparatus will suffice, but an elastic bag, with a 
suitable mouth-piece, is usually employed for this purpose. 

Physiological Actions. — If the important role which oxygen 
plays in the economy of Nature furnished a measure of its powers 
when administered as a remedy, it would be a most important thera- 
peutic agent. When inhaled in the pure state (not as air), it produces 
singularly little constitutional disturbance. A sensation of warmth in 
the larynx, trachea, and bronchi, is first experienced ; the pulse, as a 
rule, somewhat increases, though it may be lessened in frequency ; a 
sense of mental exhilaration and a disposition to greater bodily activity 
are produced ; the appetite becomes keener ; but no constant influ- 
ence on the excretions has been noted (Demarquay). Experiments 
on animals have demonstrated that the inhalation of oxygen per se 
does not have an injurious effect on animal life (A. H. Smith). On 
the contrary, as Hayem has recently shown, the administration of 
oxygen in from forty to ninety litres per day, given in two doses and 
mixed with a determinate quantity of air, energizes to a considerable 



34:2 ANTISEPTICS. 

degree the nutritive functions ; it increases the appetite, slightly ele- 
vates the temperature, stimulates the cardiac movements, and aug- 
ments the body- weight. These results are due in the main to the ef- 
fect of oxygen on the blood ; it increases the number and stimulates 
the organic activity of the red blood-globules. Although this action 
is not constant, the effects may become so by the greater nutrition- 
al changes which are thus promoted. When the inhalations are sus- 
pended, these effects on the blood cease. Anne's results, obtained by 
a course of experiment on himself, entirely confirm those obtained by 
Hayem. 

Therapy. — Oxygen is indicated and has been used with success in 
diseases of the respiratory organs, characterized by dyspnoea, due to 
causes interfering with the oxygenation of the blood, in emphysema, 
asthma, croup, asphyxia, chloroform narcosis, asphyxia from toxic 
gases, etc. In these cases oxygen acts in a manner which is* perfectly 
obvious : the labor of breathing and the damage to the respiratory 
center are lessened by the addition to the blood of oxygen in larger quan- 
tity than is supplied by the air. In these cases, pure oxygen, or a mix- 
ture of one part of the gas to two or three of air, may be employed. 
The more extreme the dyspnoea, the greater the necessity for undi- 
luted oxygen. 

Oxygen is also indicated, and has been successfully employed, in 
certain diseases characterized by insufficient oxidation : chlorosis, anae- 
mia, leucocythemia, diabetes, albuminuria, etc. In such cases the in- 
ternal administration of chalybeate medicines, or mineral waters, 
should accompany the inhalations of oxygen. Pure oxygen is not ne- 
cessary ; an admixture with three parts of air will suffice, and the 
inhalation should be made morning and evening. 

The evidence is satisfactory that oxygen-inhalations produce good 
results in some cases of phthisis. Those cases appear to be most bene- 
fited in which emaciation, dyspeptic symptoms, etc., have occurred, 
without marked change in the condition of the lungs. When hectic 
fever comes on, and excavations have occurred, the utility of oxygen 
has ended, except as a palliative of dyspnoea. Pinard reports a case 
of vomiting of pregnancy, uncontrollable by other means, promptly 
arrested by oxygen inhalations. Hayem gives similar facts, and also 
reports the good effects of this remedy in gastralgia, dyspepsia, and 
other functional disorders of the stomach. In cancer, chronic catarrh, 
and dilatation of the stomach, it affords relief without having a cura- 
tive action. [See page 9.) 

Ozone. — Active oxygen. — Hydrogen Dioxide. 

The peculiar odor of ozone explains the name given it by its dis- 
coverer, Schonbein, who long maintained alone the genuineness of 
this form of oxygen. It is now agreed by chemists that it is an 



CHLORINE. 343 

allotropic modification of oxygen, in which three atoms are condensed 
into two. 

The medical properties of ozone have been most successfully 
studied by Binz. It is an active oxygen, a powerful oxidizing agent, 
and therefore is so destructive as to be dangerous to handle. The 
tissues of the human body are affected by it in a peculiar man- 
ner. It sets up an acute catarrh of the respiratory mucous mem- 
brane if breathed in quantity. The coagulability of albumen is de- 
stroyed by it. It has been asserted that it causes pneumonia under 
certain unknown conditions. 

Binz finds that ozone is a cerebral sedative, that it induces drowsi- 
ness and stupor ; but this must be secondary to a primary stimulant 
effect, and may be due to changes in the protoplasm, on which it acts 
with great energy. 

Thus -far ozone has been utilized in medical practice only as a 
disinfectant. Its congener, hydrogen dioxide (hydrogen peroxide), 
with which it was at one time confounded, however, has been the 
subject of considerable therapeutical investigation, the more espe- 
cially since it has been advocated by Dr. B. W. Richardson, of 
London. 

A solution of anhydrous dioxide in distilled water, in the propor- 
tion of fifteen volumes by weight, contains three and three tenths per 
cent of the gas. The dose of this preparation is from one to three tea- 
spoonfuls three times a day. It is powerfully antiseptic, because of 
its destructive oxidizing action, and for this reason it has been em- 
ployed in diphtheria and in the specific fevers, but its utility is by 
no means clear. Locally, so powerful as to surpass all other agents 
of the antiseptic group, much good should be effected by it ; but thus 
far its therapeutic value has proved to be more fanciful than real. 

Authorities referred to : 

Andrews, Dr. J. B. The Detroit Review of Medicine and Surgery, December, 1871, 
p. 571. 

Anne, Dr. Henri. These de Paris, 1880. 

Binz, Prop. Dr. Arch. f. experiment. Pathol, und Pharmacol., for 1884. 

Birch, Dr. The Therapeutic Action of Oxygen, London, 1857. The British Medical 
Journal, December 24 and 31, 1859. 

Bricheteau, Dr. F. Bulletin General de Therapeutique, vol. lxx, p. 162. 

Demarquay, Dr. Essai de Pneumatologie Medicale, etc., Paris, 1866. 

Hacklet, Dr. C. E. New YorTc Medical Journal, vol. ix, p. 597. 

Macket, Edward. The Practitioner, vol. ii, p. 278. 

Pinard, Dr. Annuaire de Therapeutique, 1881, p. 109. 

Smith, Dr. A. H. New York Medical Journal, vol. xi, p. 152. 

Waldenburg, Dr. L. Die locale Behandlung der Krankheiten dcr Athmungsorgane, 
Berlin, 1872, p. 690, et seq. 

Chlorinium. — Chlorine. Chlore, Fr. ; Chlor, Ger. (Not official.) 
Properties. — Chlorine is a greenish-colored gas, of a persistent, 



844 ANTISEPTICS. 

penetrating, suffocating, and characteristic odor. It is soluble in water 
in the proportion of two volumes (of gas) to one. 

Aqua Chlori. — Chlorine-water is a greenish-yellow liquid, possess- 
ing the suffocating odor of chlorine. 

Liquor Sodce Chloratce. — Solution of chlorinated soda. A trans- 
parent liquid, of a greenish-yellow color, having a slight odor of chlo- 
rine, a sharp, saline taste, and an alkaline reaction. 

Calx Chlorata. — Chlorinated lime. Chloride of lime. A grayish- 
white substance, in powder or friable lumps, dry or but slightly moist, 
and nearly entirely dissolved by dilute muriatic acid, with the escape 
of chlorine. It should contain at least 25 per cent of chlorine. 

Physiological Actions. — Chlorine as a gas, or in solution in wa- 
ter, is an active irritant. Applied to the skin for some minutes, it 
causes heat and burning, increased diaphoresis, and, if the contact be 
sufficiently prolonged, vesication. Inhaled in very small quantity, 
largely diluted with air, this gas induces a sensation of warmth in the 
chest, and increases the bronchial mucus. In considerable quantity it 
is a violent irritant, excites spasm of the glottis, and sets up active 
inflammation of the larynx, bronchi, and lungs. 

Chlorine is without action when moisture is not present. Water is 
decomposed by it, chlorhydric acid is formed, and oxygen set free as 
active oxygen or ozone. The antiseptic properties of chlorine are, 
therefore, due in large part to the oxidizing powers of the liberated 
ozone. The sulphur and phosphorus compounds with hydrogen are 
decomposed by chlorine. When this gas is brought into contact with 
sulphureted hydrogen, chlorhydric acid is formed and sulphur is pre- 
cipitated. On these chemical facts rest the deodorant and disinfectant 
powers of chlorine. Binz has lately made an elaborate study of the 
effects of chlorine, and he finds that in animals it has a distinct nar- 
cotic effect ; that it suspends the functions of the cerebrum, but does 
not impair the contractility of muscle, or the irritability of nerves. 

Therapy. — Chlorine gas will arrest putrefactive decomposition of 
animal matters, and may, therefore, be employed as a preservative of 
anatomical preparations. As a deodorant and disinfectant it may be 
used to destroy foul effluvia and disease-germs. It is irrespirable in 
sufficient quantity to affect disease-germs in the living subject, and it 
destroys the colors and even texture of fabrics, so that it is rarely used 
for disinfection of the person or of the clothing of patients. 

Chlorine-water, chlorinated soda, and solutions of chlorinated lime 
are employed locally in scarlet fever, diphtheria, aphthae, and gangrene 
of the mouth and fauces. Their chief utility consists in removing 
fetor, but they probably, also, exert a toxic influence on disease-germs. 
$ Aquas chlori, § ss ; aquas destil., 3 iij ; syrupi simpl., § ss. M. 
Sig. : As a gargle or lotion for the mouth. I> Calcis chlor., 3 ss ; 
mucilaginis, 3 ss ; aquas destil., § iijss. M. Sig.: Lotion. To correct 



BROMINE. 345 

fetor of the breath, the following formula may be used : r> Calcis 
chlorat., 3 iij ; aquae destil., alcoholis, aa § ij ; ol. rosse, gtt. iv. M. 
Sig. : A teaspoonful to a tumblerful of icater. 

Chlorine- water was formerly much employed in scarlet fever, ty- 
phoid, typhus, etc. Its use in these affections was predicated on its 
power to arrest the growths and development of the morbid ferments. 
It need hardly be stated that such notions are no longer entertained. 

These chlorine preparations are unquestionably serviceable as deter- 
gent, deodorant, and antiseptic applications to sloughing and gangre- 
nous wounds. A solution of chlorinated soda is employed to prevent 
infection by animal poisons, the bite of serpents and insects, and the 
syphilitic virus. 

Formerly chlorine-w r ater and chlorinated soda were used in chronic 
hepatic affections, but there is no evidence that they are serviceable. 

The toxic effects of chlorine gas may be prevented by ammoniacal 
gas, forming ammonium chloride. Albumen is the most suitable and 
convenient antidote to the chlorine preparations taken into the stom- 
ach. It should be given freely in the form of milk, eggs, flour, etc. 

Bromum. — Bromine. Brome, Fr.; JBrom, Ger. A dark-red liquid, 
having a strong, disagreeable odor. It is sparingly soluble in water, 
more soluble in alcohol, and still more so in ether. 

Physiological Actions. — The actions of bromine, considered from 
the chemical point of view, are similar to those of chlorine : it decom- 
poses hydrogen compounds, forming bromhydric acid, and precipitating 
or separating the element associated with hydrogen. It is therefore a 
deodorant and antiseptic. The vapor of bromine is intensely irritant 
to the air-passages. It combines with the water and sets free ozone, 
which energetically attacks the mucous membrane. In sufficient quan- 
tity, laryngitis, bronchitis, and pneumonia will be produced by the 
inhalation of its vapor. Applied in the liquid form, and undiluted, 
bromine acts as an energetic and very painful escharotic. A brownish 
slough is formed, which is afterward slowly detached. Internally, by 
the stomach, bromine acts as a corrosive poison, producing violent gas- 
tritis, and the phenomena of depression and collapse, which attend the 
action of corrosive poisons in general. 

Therapy. — The vapor of bromine is an efficient remedy in acute 
coryza and hay-asthma : Ijfc Bromi, 3 ss ; alcoholis, § iv. M. Sig. : 
For inhalation. A small quantity of this solution may be placed in 
a wide-mouthed vial, and vaporized by the warmth of the hand. The 
vapor should be snuffed into the nose. It probably acts, as already 
explained, by setting free ozone. The activity of the pollen of plants, 
the presence of which gives rise to the symptoms of hay-asthma, is 
destroyed. The offensiveness of an ozama may be removed by the 
same expedient. Chronic nasal catarrh may not unfrequently be 



346 ANTISEPTICS. 

greatly benefited by the vapor of bromine. Hammond has pro- 
posed the internal use of a solution of bromine, as a substitute for 
the bromides in the treatment of epilepsy. Besides its disagree- 
able qualities, and its irritant action, it has no advantages over the 
bromides. 

The most important use of bromine is as an escharotic. For the 
destruction of chancre, it is probably the best caustic. Hospital gan- 
grene, the experience of the rebellion demonstrated, was more cer- 
tainly arrested by bromine than by any other escharotic. 

For the destruction of carcinoma uteri, this agent is preferred by 
some eminent gynaecologists. When used for these purposes, pure 
bromine is applied, by means of a glass rod, thoroughly, to the dis- 
eased or sloughing or gangrenous surface. 

The objections to the use of bromine are its fetid odor, its vola- 
tility (boils at 117° Fahr.), and the pain which attends its escharotic 
action. 

Gaseous Enemata and Inhalations. — Although some observations 
have been made on this topic (pages 8 and 9), the remarkable de- 
velopment the method has undergone, and the absorbed attention 
given to the whole subject by the medical profession and the pub- 
lic, seem to require that some additional information be laid before 
our readers. 

Rectal injections of gas, as now employed, we owe to Bergeon, of 
Lyons, France. It is a curious fact, however, that the method is a 
mere revival of a practice carried on about a century ago. Fallen 
into complete oblivion, the practice has been revived by a set of cir- 
cumstances rather accidental than designed. Rectal injections are 
among the measures utilized at medicinal springs to procure the maxi- 
mum effects from the waters, especially of those, like the sulphurous, 
that are disagreeable to the sense of taste. It was ascertained that 
the gases contained in these waters — carbonic-acid and sulphydric-acid 
gases — are the constituents that accomplish the good effects observed 
in cases of phthisis, and hence the next step consisted in the applica- 
tion of the gases themselves. The experimental observations of 
Bernard were then recalled, and also his explanation of the remark- 
able fact that these gases thrown into the rectum escape by the lungs, 
and do not therefore reach the cerebro-spinal centers. Further his- 
torical researches have brought to light the observations made toward 
the close of the eighteenth century, and every point almost is found 
to be completely anticipated. Priestley, the discoverer, and Bed- 
does and Percival, the clinicians, are thus disclosed to us as having 
used the same gases, by the same method, and for the same disease. 
Dr. Bergeon has invented a useful contrivance for making, wash- 
ing, storing up, and injecting the gases, and in an incredibly short 



GASEOUS ENEMATA AND INHALATIONS. 347 

time his method and apparatus have been employed in all civilized 
countries. 

It need hardly be formally asserted that improvements, or, at 
least, modifications in the method, have been proposed. The inhala- 
tion of the same gases has been substituted for the injection, by Dr. 
Dupont, of Lyons, and with manifest advantage. The sedative effects 
of carbonic-acid gas, and the germicide action of sulphureted hydro- 
gen, are obtained directly by inhalation, and without the need of ap- 
paratus. There is, however, now, a material having active germicide 
powers, which is applied by inhalation with entire facility. We 
refer to the combination of gases, liquefied, known as " Pictet liquid." 
It consists of sulphurous-acid and carbonic-acid gases, liquefied by a 
pressure of three atmospheres, and stored in siphon bottles. When 
the valve of the bottle is opened the gases escape, and so intense is 
the cold caused by the rapid evaporation that a part of the carbonic 
anhydride is frozen into snow. Pictet liquid is a powerful germicide, 
and hence its utility in affections of the broncho-pulmonary tract, and 
to prevent the development — the pullulation — of the bacillus tuber- 
culosis. If the reader will refer to the article on sulphurous acid, he 
will find there some observations on the powers of this substance 
as a remedy in tuberculosis, and on the comparative safety of its 
inhalation. 

So powerful a preparation as the Pictet liquid must be inhaled 
with care and discretion, but, as pyridine is inhaled, this liquid can be. 
A closet, or room of small dimensions, which can be closed, is selected ; 
all carpets, hangings, bedding, and furniture, except a small table and 
chair, are removed ; the slightest pressure on the valve permits a 
little gas to escape, and diffusion through the air of the room then oc- 
curs. As, indeed, only the patient can judge accurately of the effect 
produced, he should be instructed to permit the gas to escape in very 
minute quantity until the amount desired is obtained. A peculiar 
brassy taste, a slight sense of constriction of the throat, a little cough, 
and a faint feeling of oppression, are the effects to be obtained and to 
be kept up for an hour or two at each sitting, twice or three times a 
day. If begun with caution, and conducted with discretion, the very 
best results may be expected. 

Sufficient experience has now been had to enable a judgment to be 
formed of the real value of gas enemata in the treatment of pulmonary 
diseases. There are, and have been from the first, several embar- 
rassing considerations in the way of correct conclusions. The novelty 
of the expedient, the high claims put forth, the reported cures, and 
sudden enthusiasm, inflamed alike the imaginations of patient and 
physician, and a sober estimate of the actual value of gas-injections 
was well-nigh impossible. Thus much may be maintained as true, 
however — many patients are quickly benefited, cough, expectoration, 



348 ANTISEPTICS. 

fever, and sweats subsiding, while the appetite improves, and the gen- 
eral condition grows rapidly better ; but it is found presently that 
the bacillus does not disappear, and that the improvement is more 
apparent than real, is not maintained, and that the continued use of 
gas-injections becomes irksome, at last impossible. In not a few in- 
stances the practice can not be carried out because of the local irrita- 
tion ; and there are many phthisical subjects not amenable to the 
method at all, or have a natural inaptitude that admits of no training. 
There appears to be a growing conviction that those phthisical sub- 
jects who have experienced much benefit from the treatment owed 
this result to the influences so strongly affecting the imagination of 
both patient and practitioner. 

Various examples of asthma, of emphysema, and of chronic bron- 
chitis have been reported cured, but the fallacy underlying these 
statements is only too obvious. Spasmodic asthma — the neurosis — 
it is probable, can be cured, and a single gas-injection might suffice ; 
but the conditions are greatly different in the other maladies, and, 
although very striking improvement may be witnessed, cures do not 
necessarily follow, nor, indeed, have they been effected. After a 
candid survey of the whole subject, the author finds himself in this 
attitude — that the inhalation of gases is a more rational, effective, 
and convenient method of treating pulmonary diseases than by rectal 
injections. 

Referred to, for gas-injections : 

Beddoes, Dr. Quoted by Dupont. 

Bergeon, Dr. Bui. Gen. de Therap. Various articles during 1886 and 1887. 

Dujardin-Beaumetz. Bui. Gen. de Therap. November, 1886. 

Dupont, Dr. Maurice. Bui. Gen. de Therap. January 15, 1887. 

Durand-Fardel, Dr. Quoted. 

Minot, Dr. Francis. The Medical Record for 1887. 

Paul, Dr. C. Apparatus for Gas Injections. 

Percival, Dr. On Fixed Air. 1768. 

Priestley, Da. Experiences with Different Kinds of Fixed Air. 1774. 

Acidum Carbulicum. — Carbolic acid. Phenique acide, Fr. ; Car- 
bolsaure, Ger. A product of the distillation of coal-tar. Is either 
in acicular crystals or in crystalline masses ; white or colorless 
when perfectly pure, but, even when slightly impure, either reddish 
or becoming so on exposure ; deliquescent and readily assuming 
the liquid state in the presence of a little water, yet not dissolv- 
ing ; of a strong odor and taste, recalling those of creosote, but 
distinct ; fusible at from 93° to 106°, forming an oily liquid. It 
is soluble in from twenty to thirty-three parts of water, the purest 
being most soluble. Alcohol, ether, chloroform, glycerin, and the 
essential oils, dissolve it freely. It combines with alkalies and oth- 
er salifiable bases, but its compounds have still an alkaline reaction 



CARBOLIC ACID. 349 

and are decomposed by the feeblest acids, even by carbonic acid. 
Dose, gr. f— gr. j. 

Acidum Carbolicum Crudum. — Impure carbolic acid. Is either 
colorless or has a brown shade. It consists of carbolic and cresylic 
acids, in variable proportion, with impurities derived from coal-tar, 
which vary from ten to thirty per cent. 

Glyceritum Acidi Carbolici. — Glycerite of carbolic acid (not of- 
ficial), ( 1 ij carbolic acid ; half a pint of glycerin). 

Aqua Acidi Carbolici. — Carbolic-acid water (not official), (glycer- 
ite of carbolic acid, 3 x ; water, one pint). Dose, a teaspoonful to a 
half -ounce. 

TTnguentum Acidi Carbolici. — Ointment of carbolic acid. (Car- 
bolic acid, 10 parts ; ointment, 90 parts.) (U. S. P.) 

Creosotum. — Creosote. A product of the distillation of wood-tar. 
A colorless, oily, neutral liquid, having a strong, characteristic odor, 
and an acrid, burning taste. Is sparingly soluble in water, but mixes 
in all proportions with alcohol and ether. 

It is distinguished from carbolic acid, which in most respects it 
closely resembles, by not coagulating collodion when mixed with it, 
and by not imparting a blue color to a slip of pine-wood dipped first 
into an alkaline solution of creosote, and then, after drying, into mu- 
riatic acid. 

Aqua Creosoti. — Creosote-water (creosote, 1 part ; distilled water, 
99 parts). Dose, a teaspoonful to an ounce. 

Carbolic acid has largely superseded creosote as a remedy. 

Antagonists and Incompatibles. — Combination with alkalies di- 
minishes, but does not entirely check, the physiological activity of 
carbolic acid. Saccharate of lime, or lime, is probably the most effi- 
cient antagonist from the chemical point of view (Th. Husemann). 
In cases of poisoning, this substance should be given freely. The 
mucous membrane should be protected as far as possible by the ad- 
ministration of vegetable demulcents, but not by oils and glycerin, 
which favor absorption. I am indebted to Dr. A. C. Post, of New 
York, in a verbal communication, for the important fact that atropine 
is a physiological antagonist to the systemic symptoms induced by 
carbolic acid. He was induced to administer atropine in a case of 
poisoning by carbolic acid, on observing the minutely contracted pu- 
pils and the failing circulation. The result was successful. Similar 
success has attended the same practice in other cases. Experiments 
on animals have also demonstrated the existence of this antagonism, 
which may now be regarded as an established fact. The rules for 
guidance in the administration of atropine are the same as in other 
cases : a sufficient quantity of the antagonist is administered to main- 
tain dilatation of the pupil and to overcome the depression of the cir- 



350 ANTISEPTICS. 

dilation and respiration. Elimination should also be promoted by the 
free use of diluents. 

Synergists. — All of the phenols, the antiseptics, the motor depres- 
sants, etc., increase the effects of carbolic acid. 

Physiological Actions. — Applied to the integument or to the 
mucous membrane, carbolic acid produces a burning sensation of 
short duration, and there is formed a whitish, superficial eschar, which 
subsequently becomes brownish. The taste of carbolic acid is sweet- 
ish, cooling, and then pungent and hot. When swallowed by accident 
or design, the mucous membrane appears as if brushed over with a 
strong solution of nitrate of silver, and becomes hard and dry like 
leather. This appearance is observable about the lips, fauces, the 
oesophagus, the cardiac and pyloric extremities of the stomach, and 
the summits of the folds of the mucous membrane in the organ gen- 
erally. This change in the condition of the membrane is due to the 
power of carbolic acid to coagulate the albumen of the tissues. Vom- 
iting is not constant, even when toxic doses are swallowed, and the 
vomited matters smell of the poison. From medicinal doses, a cooling, 
rather grateful sedative effect is experienced in the stomach. It dif- 
fuses into the blood with great facility, from the stomach, from the 
external integument, and from wounded surfaces. Cases of poison- 
ing have resulted from application to a patch of psoriasis (Toel), to 
scabies (Hoppe-Seyler, Machin), to the uterine cavity, after the enu- 
cleation of a fibroid (Rheinstadter), to abscesses (Kohler, Wallace, 
White), to the rectum for the relief of ascarides (Pinkham, Mi- 
chaelis), and to the integument and wounds, in cases of antiseptic 
surgery. Diffusion takes place with such rapidity, from these various 
sources, that formidable symptoms arise in a few minutes. The 
amount necessary to produce distinct effects varies ; besides the dif- 
ference due to age, there are variations in susceptibility. A one-per-cent 
solution has caused serious symptoms when injected into an abscess 
and into the rectum. Six drops of the pure acid have caused danger- 
ous symptoms, and a teaspoonful has terminated fatally, but one case 
is reported in which this amount was recovered from when taken by a 
child two and a half years old (Dessau). A tablespoonful has caused 
death in several instances (Cowling, Packer, and others). In Hoppe- 
Seyler's cases, while the two apprentices were rubbing each other's 
backs, both were seized suddenly with giddiness, vertigo, and tension 
of the head, and quickly passed into unconsciousness. These effects 
are also experienced when the poison is taken into the stomach. The 
warnings of danger, which may be expected when the remedy is 
brought in contact with the tissues at any point, are, besides the local 
irritation, sudden vertigo, contracted pupils, pallor of the face, em- 
barrassed respiration, and feeble circulation. When the dose is a fatal 
one, unconsciousness quickly supervenes, the breathing becomes ster- 



CARBOLIC ACID. 351 

torous, the surface grows cold, the action of the heart gets more and 
more feeble, and death finally occurs from failure of respiration. Con- 
vulsions occur in animals, but in man this symptom is wanting, or at 
most fibrillary trembling, and some trismus of the jaws, are present. 

The changes in the blood induced by carbolic acid have been much 
disputed. That it enters the blood as carbolic acid seems positively 
established, although, having acid properties, it may become a carbolate. 
The acid has been discovered in the blood by Hoppe-Seyler. That it 
appropriates oxygen and thus undergoes some change in the blood is 
highly probable. Husemann maintains that the blood in carbolic-acid 
poisoning is very much altered in character, becoming dark in color 
and coagulating with difficulty, but in the reports of various post-mor- 
tem examinations it is remarked that the blood was coagulated in the 
heart and great venous trunks. Outside of the body the blood is 
quickly changed on the addition of carbolic acid, but these changes do 
not correspond to those which occur within the body. The action of 
the heart is at first slowed, but toward the end it becomes rapid. The 
blood-pressure falls considerably below the normal, due, Hoppe-Seyler 
says, to vaso -motor paresis. The first slowing of the heart is caused 
by stimulation of the end-organs of the vagus, and is prevented by 
division of the trunk of the nerve. The subsequent rapid action is 
due to the removal of the inhibition from paralysis of the vagus. Res- 
piration is at first stimulated and the respiratory acts are more frequent, 
but they are also more shallow. Division of the pneumogastrics does 
not entirely prevent this stimulation, although it lessens the effect, 
whence it is concluded that carbolic acid also stimulates the respiratory 
center in the medulla (Salkowsky). This conclusion is strengthened 
by the fact that, if the vagi are previously divided, the administration 
of carbolic acid will still increase the respiratory acts for a time, show- 
ing that the stimulation of respiration must be effected by an action 
on the end-organs of the vagi in the lungs as well (Salkowsky). Low- 
ering of the temperature has been constantly observed in the experi- 
ments on animals, and in the cases of poisoning of man. The surface 
of the body is cool, and more or less livid. There are several factors 
concerned, doubtless, in the reduction of temperature. The diminu- 
tion in the blood-pressure and the arrested oxidation are the chief. 
The power of carbolic acid to reduce the temperature of fever is also 
clear, but in this respect it is inferior to salicylic acid (Eisenstein). In 
cases of poisoning the reduction of temperature reaches several de- 
grees, but in the normal condition in man ordinary medicinal doses 
have but little effect in this direction. 

A more or less minutely contracted pupil is a nearly constant phe- 
nomenon in carbolic-acid poisoning. It can hardly be doubtful that 
this effect is due to paralysis of the radiating fibers, leaving the cir- 
cular fibers unopposed. Carbolic acid unquestionably acts on the 



352 ANTISEPTICS. 

cerebral lobes — on the centers of conscious impressions — and suspends 
their functions. Vertigo and singing in the ears occur, and then con- 
sciousness is lost, the reflexes are suspended, and complete muscular 
resolution ensues. In warm-blooded animals clonic convulsions are 
produced, succeeded by paralysis. By direct application, as Bill was 
the first to demonstrate, carbolic acid suspends the irritability of the 
sensory nerves. If a tract of the integument be painted over with 
pure carbolic acid, an incision may be made into the part without the 
least pain being experienced. The peripheral nerves, sensory and mo- 
tor, are not affected by the systemic action. The muscles after poison- 
ing respond energetically to the usual forms of stimulation. It follows, 
then, that the action of the poison is centric and not peripheral (Sal- 
kowsky, Lemaire, Rothe). 

The elimination of carbolic acid takes place by various channels 
of excretion, chiefly by the urine. It may be detected by the odor in 
the breath of poisoned animals (Lemaire). It has been found in the 
saliva by Hoppe-Seyler, but Bill could not detect it in the perspiration 
or in the faeces. Hoffmann maintains that carbolic acid undergoes oxi- 
dation in the blood, but, as a part of it may be separated unchanged 
from the urine, this statement is not wholly true. That much of the 
carbolic acid taken is oxidized before being excreted is proved by the 
character of a secondary product which appears in the urine. One of 
the earliest indications of the toxic action of carbolic acid, especially 
when applied locally, is a dark-greenish, blackish, or smoky hue of the 
urine. Although this appearance does not actually prove that danger 
to life is imminent, it is a warning to be heeded. One of the results 
of the oxidation of carbolic acid is the formation of oxalic acid. The 
same process takes place in animals, in whom carbolic acid is excreted 
as oxalic. Doubt has been thrown on the methods by which carbolic 
acid is detected in the urine of those taking it, through the experiments 
of Stadeler, who has discovered that carbolic acid is present in normal 
urine. Hoppe-Seyler, however, has proved that, by Stadeler's process* 
carbolic acid is made from the indican of the urine (Hermann). The 
elimination of carbolic acid taking place through so many channels is 
readily effected, and probably the whole amount is thrown out in 
twenty-four hours. When death occurs very quickly in fatal cases of 
poisoning, the tissues and organs will smell distinctly of the poison 
(Ogston). Death has occurred in a few minutes — in a great majority 
of the fatal cases within two hours (Jeffreys), and is rarely postponed 
to two days. The amount of carbolic acid present will therefore vary. 

There are no characteristic post-mortem appearances, except the 
changes wrought at the points of contact with the acid. The mucous 
membrane of the mouth, fauces, oesophagus, and stomach, where acted 
on, appears corrugated, tough, and discolored — whitish changing to 
brownish discoloration, surrounded by a zone of hyperemia, or capil- 



CARBOLIC ACID. 353 

lary haemorrhages here and there sloughing off. Congestion of the 
viscera generally, especially of the brain and the meninges, is a con- 
stant phenomenon. The lungs are oedematous as well as congested. 
The heart may be distended with loose clots, and relaxed, or empty 
and contracted. By some observers changes akin to those of phos- 
phorus-poisoning have been uniformly discovered (Neumann), i. e., 
acute fatty degeneration of liver, heart, kidneys, and other organs, 
notably the renal epithelium. Husemann, Salkowsky, and others, 
deny the reality of these observations, so that further examinations 
are necessary to determine this point. 

Therapy. — Nausea and vomiting due to an irritable state of the 
stomach-nerVes are relieved by carbolic acid. Combination with bis- 
muth enhances the effect. £) Acidi carbolici, grs. iv ; bismuthi sub- 
nitrat., 3ij; mucil. acaciae, §j; aquae menth. pip., 5 iij. M. Sig. : A 
tablesp>oonfid every two, three, or four hours. Attacks of cholera mor- 
bus and cholera infantum are not unfrequently very promptly arrested 
by the exhibition of carbolic acid, or the combination of carbolic acid 
and bismuth. Eructations of gas, due to the fermentation of foods, 
and the vomiting of yeast-like matters, especially when due to the 
presence of sarcina, are often arrested by this remedy. Good results 
have been obtained by the use of carbolic acid in Asiatic cholera. 
Combination with iodine is said to be more effective (Choleratropfen). 
1^ Acidi carbolici, grs. iv ; tinct. iodi, gtt. xvj ; aquae menth. pip., 
§ iv. M. Sig. : A tablespoonfid every hour, or oftener. The same 
formula has been used successfully in cholera nostras and cholera in- 
fantum (Rothe). 

Based on its power to arrest the action of ferments, carbolic acid 
has been used, with certainly temporary good results, in diabetes of 
hepatic origin (Ebstein, Habershon). 

Inhalations of carbolic-acid spray possess a high degree of utility 
in chronic nasal catarrh, hay-asthma, chronic bronchitis, and whoop- 
ing-cough. A solution in water, to the proportion of one per cent, is 
a suitable solution for this purpose. It may be combined with the 
tincture of iodine. The efficacy of these inhalations in hay-asthma 
and in whooping-cough is probably due to the fact that carbolic acid 
destroys the minute organisms (cacobacteria, pollen), on the presence 
of which the morbid action in these maladies depends (Letzerich). The 
vapor of carbolate of iodine may be inhaled in these diseases. The 
warmth of the hand suffices to vaporize a mixture of carbolic acid and 
tincture of iodine. 

In pulmonary phthisis, when there is much teasing cough, or when 
expectoration is profuse and foul-smelling, these inhalations are ser- 
viceable. In gangrene of the lung, carbolic spray and the acid inter- 
nally are used to destroy the fetor. A one-per-cent solution of car- 
bolic acid and a mixture of carbolic acid and iodine have been injected 
24 



354 ANTISEPTICS. 

with asserted advantage into phthisical cavities through the parietes 
of the thorax. 

Internally, also, creosote and carbolic acid, especially the former, 
have been used with conspicuously good results in the treatment of 
the several forms of consumption, except phthisis florida. Probably 
the most useful observations to illustrate this point are those of MM. 
Bouchard and Gimbert. They used pure creosote from wood, and in 
the following formula : Pure creosote, 13*5 parts ; tincture of gentian, 
30 parts ; alcohol, 250 parts, and sufficient Malaga wine to make up a 
thousand parts. Of this solution from two to five tablespoonfuls are 
taken daily. In other cases the creosote was given in cod-liver oil, 
which is an excellent vehicle — 2 parts of pure creosote to 150 parts of 
cod-liver oil. The daily quantity varied from six to nine grains, and 
in rare cases from twelve to fifteen grains. Of ninety-three cases of 
phthisis treated with this remedy, twenty-five were apparently cured, 
twenty-nine were improved, eighteen remained no better, and twenty- 
one died. Creosote thus had a good effect in fifty-four out of ninety- 
three cases. The evidences of improvement consisted in the diminution 
of the expectoration, cough, and fever, and increase in the appetite, 
strength, and weight of body. The diminution of the expectoration, 
and consequently of the cough, was the first evidence of improvement, 
although at the beginning of the treatment the cough is apt to be in- 
creased for a short time by creosote. If the cough and expectoration 
are constantly increased, the medicine must be stopped. The danger 
of haemoptysis is rather lessened than increased by the creosote treat- 
ment. Schnitzler, of Vienna, has employed, recently, the subcutane- 
ous injection of carbolic acid in more than one hundred cases of con- 
sumption. He practiced the injections daily, sometimes twice a day, 
administering each time from one eighth to one fourth of a grain. 
The result was, in most cases, the fever was reduced, the pulse became 
slower and stronger, and the night-sweats were diminished. He con- 
cludes that these injections are nearly if not quite as effective in re- 
lieving hectic as quinine. 

Influenced by the germ theory of disease, carbolic acid has been 
much prescribed in the treatment of typhoid fever, diphtheria, scarlet 
fever, erysipelas, etc. Whether the theory be true or false, there can 
be no doubt of the good effects of creosote and of carbolic acid in 
these diseases. Pecholier, of Montpellier, has given creosote in sixty 
cases of typhoid, set apart for study of the results of the action. 
Good effects were obtained ; the temperature kept down ; the delir- 
ium and insomnia were much less ; the intestinal disturbance declined, 
and thus the violence of the disease was distinctly lessened. M. Cha- 
pelle maintains that it cuts short an attack of typhoid. In the other 
maladies above named, the evidence of the good effects of carbolic 
acid is constantly accumulating. Besides the internal administration, 



CARBOLIC ACID. 355 

local application to the fauces of spray, or suitable solutions, are use- 
ful in diphtheria and scarlet fever to remove fetor, and to destroy the 
germs of contagion which may be lodged there. Recently Rothe has 
treated a number of cases of typhoid fever, with great success, by a 
mixed antiseptic and antipyretic method, in which he employs carbolic 
acid and iodine administered in infusion of digitalis. The author has 
for several years treated the cases of typhoid and typho-malarial fever 
so called, which have been in his hands, with a drop each of tincture 
of iodine and liquefied carbolic acid every two or three hours, with 
results which were certainly most favorable. As Rothe has observed, 
this antiseptic treatment lowers the heat, lessens the diarrhoea, im- 
proves the mental state, and, indeed, diminishes the severity of the 
disease remarkably. The value of carbolic acid as a remedy in mala- 
rial fevers seems now conclusively established. The experiences of 
Eisenstein in the Vienna General Hospital are especially valuable. 
He obtained distinct curative effects in twenty-four cases of the tertian 
and in four cases of the quotidian type of intermittents. The author 
has found the combination of carbolic acid and iodine of great value 
in chronic malarial infection, and in the more acute cases after quinine 
has stopped the paroxysms. As an antipyretic, Eisenstein justly re- 
gards carbolic acid as inferior to salicylic. It is probable that resor- 
cin, hydroquinone, and other phenols, will prove more useful than either. 
Dr. Lecaille has found carbolic acid remarkably efficacious in yellow 
fever, and even after the occurrence of the ominous " coffee-grounds " 
vomit. He administers it both subcutaneously and by the stomach. 

The dose of carbolic acid for internal use ranges from half a grain 
to two grains, or of the liquefied acid from half a minim to two min- 
ims. It may be given in mint-water, which covers the odor some- 
what. This quantity may be repeated every hour or two, if necessary, 
without producing ill effects, if not too long continued. As mentioned 
above, the quantity given by Bouchard and Gimbert sometimes 
reached as high as fifteen grains a day. The mixture of bismuth, 
mucilage, and glycerin, is an excellent vehicle. When iodine and 
carbolic acid are given together, a colorless carbolate is formed when 
they are dropped into water. 

Parenchymatous Injection or Carbolic Acid. — The deep-seated 
injection of carbolic acid has been proposed and successfully practiced 
for the relief of various morbid states. For this purpose a two- to 
five-per-cent solution is most suitable. A solution stronger than this 
may excite inflammation in the part and coagulate the blood. It is 
directed by Htiter that the needle of the hypodermatic syringe be first 
inserted into the inflamed part, and, if no blood flows out through the 
needle, it will be known that a vein has not been penetrated. From 
twenty to thirty minims of the solution are then injected. The injec- 
tions are made once or twice a day in acute diseases, and on alternate 



356 ANTISEPTICS. 

days, or less frequently, in chronic cases. Very remarkable results 
have been obtained from these injections in erysipelas (Htiter, Auf- 
reeht) and in pleuro-pneumonia (Kunze). 

Dr. Tessier, of the Mauritius, reports that intermittents are rapidly 
cured by the injection of three quarters of a grain of carbolic acid dis- 
solved in twenty minims of water. 

The parenchymatous injection of carbolic acid is more especially 
adapted to the treatment of certain surgical maladies. Htiter has 
employed this method successfully in lupus, chancroid, secondary 
syphilitic abscesses, idcerations, synovitis (injected into the affected 
joint), fistidoe, enlarged bursce, hydrocele, etc. Levis, of Philadelphia, 
cures hydrocele by injecting liquid carbolic acid into the sac after 
drawing off the fluid. He first inserts the needle of the syringe so 
that it may be certain the point rests in the cavity. Then the fluid is 
drawn off, and finally the acid, a drachm or two, is injected through 
the needle., 

Local Application of Carbolic Acid. — Itching of the shin, aris- 
ing from any cause, is allayed by sponging the part with a solution of 
carbolic acid. t> Acid, carbol., 3 ij ; glycerini, § j ; aqua rosse ad 
| viij. M. Sig. : Lotion. This application is especially serviceable 
in prurigo and prurigo sinalis. Carbolic acid is an effective applica- 
tion in parasitic skin-diseases — pityriasis versicolor, tinea tonsurans, 
tinea circinata, favus, scabies, etc. t^ Acid, carbol., 3 j ; glycerini, 
| j. M. Sig. : Local application for parasitic skin-diseases. The in- 
ternal administration of carbolic acid should be conjoined with its local 
use in prurigo, chronic eczema, and sycosis parasitica. 

The following is an efficient local application for chilblains: t> 
Acid, carbol., 3 j ; tinct. iodi, 3 ij ; acid, tannici, 3 ij ; cerat. simpli- 
cis, J iv. M. Sig. : Ointment. 

Undiluted carbolic acid is used as a mild escharotic to the so-called 
mucous patches, to condylomata, vegetations, etc., lupus, scirrhus, cau- 
lifloioer-growths, etc. The author has witnessed results which appear 
to him to justify the statement that carbolic acid, applied undiluted 
to the cancerous sore and injected underneath, limits the extension 
and retards the growth of the disease. In several cases, the disease 
having recurred at the site of the operation for its removal, the author 
has apparently arrested the morbid process by injecting beneath and 
into the new formation daily a syringeful of a five-per-cent solution 
of carbolic acid. The action in these instances seemed to be local : 
there were none of the evidences of systemic impression of the poison, 
and no diffusion of the cancer-germs took place from the point of in- 
fection. If further experience confirms these observations, we have in 
this method a most important contribution to our resources. 

Undiluted carbolic acid is an efficient application to xdcers of the 
cervix uteri, chronic endo-cervicitis, and endo-metritis. It may be ap- 



CARBOLIC ACID. 357 

plied undiluted without risk to the raucous membrane of the uterine 
cavity, on the cotton-wrapped probe, after preliminary dilatation of 
the canal. There is, probably, no better means of treating uterine 
catarrh. 

Solutions of carbolic acid, of average strength, have the power to 
check suppuration, and to correct the fetor of sloughing and ill-condi- 
tioned wounds. The methods of Mr. Lister's antiseptic treatment in- 
clude a much more extended application of carbolic acid. Embrac- 
ing the fermentation theory of M. Pasteur, Mr. Lister holds to the 
necessity of excluding germs from contact with wounded surfaces. 
Operations by the method of Mr. Lister must be performed under and 
in a spray of carbolic acid (one part to forty). The solution may be 
pulverized by the ordinary hand-ball atomizer, or better by a Siegle's 
steam atomizer. All knives, sponges, and ligatures must be " car- 
bolized " before coming into contact with the wounded surface. The 
antiseptic dressing is thus described by Mr. Lister : " It consists of 
two pieces of folded gauze and mackintosh (fine cotton cloth with a 
layer of caoutchouc), an anterior and a posterior one. The wound is 
covered with several thicknesses of gauze dipped in a solution of car- 
bolic acid (one to forty), and over this is placed the folded gauze and 
mackintosh, of sufficient size to extend beyond the margins of the 
wound in all directions." The dressing is confined by turns of a 
" gauze bandage," and is allowed to remain undisturbed for from two 
days to a week, " the general rule being that the dressing should be 
changed on any day on which the discharge is observed to have ex- 
tended beyond the edge of the folded gauze." 

Antiseptic gauze consists of cotton cloth charged with the follow- 
ing : " One part of crystallized carbolic acid, five parts of common res- 
in, and seven parts of solid paraffin " — the paraffin and resin are first 
melted together, and the acid is then incorporated by stirring. A very 
complicated process, too elaborate for insertion here, is described by 
Mr. Lister, for diffusing the above-described mixture equably through 
the cotton cloth. For lubricating instruments, especially catheters 
and bougies, he advises a solution of one part of carbolic acid in 
twenty parts of olive-oil. Carbolized silk sutures are " prepared by 
immersing a reel of the silk in melted beeswax, mixed with about a 
tenth part of carbolic acid, and drawing the thread through a dry 
cloth as it leaves the liquid, to remove superfluous wax." 

The following is the University College formula for the prepara- 
tion of carbolic-acid plaster : " Shellac, 75 ; carbolic acid, 25. Melt 
the shellac with 8 of the acid, and then add the remaining 17, and mix 
thoroughly. The mixture should be spread on linen, and should be 
coated with a solution of gutta-percha in bisulphide of carbon." 

The admirable results in the treatment of wounds obtained by Lis- 
ter have been fully confirmed by various competent observers (Nuss- 



358 ANTISEPTICS. 

bauni, Thiersch, Volkmann, Bardeleben), and, although objectors have 
risen to deny the superiority of the method, it has been shown that 
the ill-success complained of was due to inattention to the various de- 
tails necessary. 

Toxic Symptoms induced by Carbolic Acid when used ex- 
ternally. — The extraordinary extent to which carbolic acid is now 
applied in surgical practice renders it necessary to devote some atten- 
tion to the symptoms indicating a dangerous degree of absorption. 
This form of poisoning occurs under two forms : one, sudden, the 
patient sinking into collapse immediately after the dressings are ap- 
plied ; the other, occurring insidiously, after some weeks of treatment 
and applications of the antiseptic dressings. Kuster, of Berlin, relates 
five cases of the first form, in which the patients, after the dressings 
were applied, sank at once into a condition of collapse like the state of 
shock from a most formidable surgical operation. Only one of these 
cases recovered. The diagnosis of this toxic state from surgical shock 
will be referred to presently. In the other form of poisoning the 
symptoms appear gradually, and are apt to be attributed to a com- 
mencing septicaemia. Loss of appetite, nausea, feverishness, head- 
ache, vertigo, and clonic spasms, are first experienced, prostration sets 
in, and a more or less profoundly comatose state develops. The onset 
of these symptoms, or the depression which initiates the morbid phe- 
nomena in the first form, occurs at a time when more favorable symp- 
toms are properly expected. But the diagnosis is arrived at readily 
by an examination of the urine. The change in the color and the 
peculiar odor of the urine observed in carbolic-acid poisoning have 
been referred to, but the chemical tests are more important. Accord- 
ing to Baumann, we have, in Sonnenberg's test, the best means of de- 
termining the presence of carbolic acid. This test depends on the fact 
that any carbolic acid in the urine unites with the sulphates to form 
the sulphocarbolates, and hence it consists in determining the amount 
of normal sulphates present. The urine is first acidulated with strong 
acetic acid, and baric chloride is then added in excess. A copious 
precipitate, consisting, for the most part, of baric sulphate, is formed, if 
the urine is healthy ; but if it contain carbolic acid, scarcely any pre- 
cipitate will be thrown down, because of the formation of soluble sul- 
phocarbolates. The researches of Baumann have furnished us with an 
antidote of a chemical kind, which may be applied if there is time. 
He has shown that sodic sulphide forms in the body, with carbolic 
acid, the innocuous sulphocarbolate, and hence a soluble sulphate, as 
Glauber's salts, will be a proper antidote. As, however, the toxic ac- 
tion of carbolic acid is very speedy, the chemical antidote may not 
have time. Under these circumstances it will be found, probably, 
that the physiological antagonist is more speedy and effective. Atro- 
pine is apparently a most certain antagonist. It has succeeded in some 



CARBOLIC ACID. 359 

very unpromising cases, and in my experiments on animals the results 
have been most favorable to the existence of the antagonism. 

Carbolic acid enters into the composition of MorrelPs antiseptic 
fluid, which is used as a disinfectant for general purposes, and for the 
preservation of bodies. The following is the formula : "Dissolve 13'5 
parts of arsenious acid and 6'9 parts of sodic hydrate in 15 to 20 parts 
of water ; add enough carbolic acid until the clear fluid, after stir- 
ring, appears turbid (that is, until the liquid is fully saturated with 
carbolic acid), and dilute with water to make 100 parts." 

Stjlphocaebolates. — Sodii Sulphocarbolas. Sulphocarbolate of 
sodium. 

Potassii Sidphocarbolas ; Calcii Sidphocarbolas ; Magnesii Sul- 
phocarbolas. 

Of these salts, the first-named is the most important, and is the 
only one official. The first step in the formation of these salts consists 
in the production of sulphocarbolic acid, obtained by dissolving one 
part of crystallized carbolic acid in an equal weight of strong sulphu- 
ric acid. The next step consists in the formation of sulphocarbolate 
of barium, from which the other salts are obtained by double decom- 
position. 

Sulphocarbolate of sodium occurs in transparent rhombic prisms, 
which are permanent in the air, dissolve in about five parts of water, 
and are also soluble in glycerin and alcohol. Most of the sulphocar- 
bolates have a faint pinkish tint, and are, like the soda-salts, soluble in 
water, alcohol, and glycerin. The dose for internal administration 
ranges from ten to thirty grains. Saturated or weaker solutions may 
be employed topically. 

These preparations, devised by Dr. Sansom, were intended to secure 
the antiseptic and antipyretic action of carbolic acid without any of 
the caustic and depressing action of the latter. In such septic diseases 
as diphtheria, the eruptive fevers, puerperal fever, they may be used 
freely. There seems little ground for the assumption that the carbolic 
acid is freed from its associates in passing through the organism, for 
the sulphocarbolates do not have the effects of carbolic acid, and the 
urine does not have the greenish, blackish, or smoky hue characteristic 
of the latter remedy. There can be little doubt that the sulphocar- 
bolates are excellent topical applications to the inflamed mucous mem- 
brane, wherever accessible. The author has had good results from 
their use in acute inflammation of the fauces, in tonsillitis, in catarrh 
of the nares, in otorrhoea, and also in gonorrhoea. These salts are 
useful as deodorant and antiseptic applications to unhealthy wounds 
and ulcerated surfaces, to aphthm in children, etc. Although the 
sulphocarbolate of sodium has been added to the new pharmacopoeia 
list, it must be admitted that the sulphocarbolates do not maintain the 
position to which they were first introduced. 



360 ANTISEPTICS. 

Trichlorphenol. — A preparation of much promise and which has 
yielded good results is that named trichlorphenol. It is produced by 
a combination of chlorinated lime and carbolic acid. A saturated 
solution of chlorinated lime is treated with a saturated solution of 
carbolic acid. Trichlorphenate of calcium is a product of the reac- 
tion, and remains in solution held by the chloride of calcium, another 
product. If to this solution some hydrochloric acid is added, the tri- 
chlorphenol is precipitated. 

A method of extemporaneous preparation for merely topical uses 
consists in the following : One pound of a solution of carbolic acid, 
four per cent in strength, is mixed with five pounds of solution of 
chlorinated lime and then filtered. If, for some purposes, this solu- 
tion is too strong, it can be diluted with boiling water to the required 
strength. 

According to Diannin, who first proposed this preparation, it has 
an antiseptic power twenty-five times greater than carbolic acid, and 
far exceeds thymol, salicylic acid, and chlorinated lime. It has proved 
highly effective in erysipelas, the solution painted over several times 
a day (Yurinsky). A one-per-cent solution has also been successfully 
used in the treatment of ulcers (Butckik). Other testimony has been 
published as to its utility in erysipelas, as an injection in leucorrhoea 
and in dysentery. On the other hand, Dr. Thomaschewsky has been 
disappointed in his clinical trials, finding it inferior to iodoform. 
The truth, as is usual under these circumstances, probably lies in 
the means. 

Authorities referred to : 

Aufrecht, Dr. E. Schmidt's Jahrbucher, vol. clxiv, p. 147. 
Bill, Dr. J. H. American Journal of Medical Sciences, October, 1870. 
Butckik, Dr. Virchoio u. Hirsch's Jahresbericht for 1885. 
Diannin, Dr. Ibid. 

Declat, Dr. G. Nouvelles Applications de VAcide Phenique, etc., Paris, 1865. 
Eisenstein, Dr. Von Ritter. Wiener Med. Presse, No. 35, 1878. 
Gimbert et Bouchard. Gaz. Hebdom., Nos. 31, 33, 1877. 
Grote, Dr. C. H. Diss. Berolini. Die Carbolsdure in der Medicin. 
Habershon, Dr. S. 0. Guy's Hospital Reports, vol. xv, 1869-'70, p. 530. 
Hoppe-Seyler, F. Schmidt's Jahrbucher, vol. civ, p. 273. 
Hueter, Dr. G. Schmidt's Jahrbucher, vol. clxiv, p. 144. 
Husemann, Dr. Theod. Deut. Klinik, 1870 and 1871. 

Kohler, Dr. H. Handbuch der physiologischen Therapeutik, 1876, p. 1206, 
et seq. 

Kunze, Dr. C. F. Schmidt's Jahrbucher, vol. clxiv, p. 147. 

Lemaire, Dr. Jules. De VAcide Phenique, Paris, 1863, p. 754. 

Letzerich, Dr. Ludwig. Virchow's Archiv, Band lx, p. 409. 

Ibidem. Band lvii, p. 518. 

Lister, Dr. Joseph. The Lancet, vol. i, 1875. 

Ibidem. TJie British Medical Journal, vol. ii, 1875, p. 518. 

Neumann, Dr. Isidor. Schmidt's Jahrbucher, vol. cliii, p. 141. 



SALICIN. 361 

Rothe, Dr. C. G. Die Carbolsaure in der Medicin, Berlin, 1875, p. 63. 
Salkowski, Dr. Schmidt's Jahrbucher, vol. civ, p. 272. 
Taylor, Dr. A. S. On Poisons, third edition, 1875, p. 243. 
Taylor, Dr. W. E. Philadelphia Medical Times, vol. ii, p. 284. 
Thomaschewsky, Dr. Virchow tend HirscWs Jahresbericht for 1886. 

Salix. — Salix. The bark of Salix alba Linne, and of other species 
of Salix (Nat. Ord. Salicacem). 

Salicinum. — Salicin. A neutral principle obtained from the bark 
of Salix helix Linne, and of other species of Salix. Colorless, white, 
silky, shining crystals, permanent in the air, odorless, having a very 
bitter taste and a neutral reaction. Soluble in 28 parts of water, and 
in 30 parts of alcohol at 59° Fahr. ; insoluble in ether or chloroform. 
Dose, 3j — 3 ij. So little soluble, and light in weight and bulky, it 
were better administered in a wafer, powder, or emulsion. 

Actions and Uses. — Salicin promotes appetite and the digestion — 
properties which it possesses in common with other bitters. It is an 
antiferment, and has antiseptic powers similar to quinine and salicylic 
acid. The latter is a derivative of salicin. It is destructive to bac- 
teria and vibrio, and prevents the reaction of amygdalin and emulsin, 
and of ptyalin on starch. It does not produce very sensible effects 
even in large doses, and is without toxic activity. It has been used 
as a substitute for quinine in the cases of disease to the treatment of 
which the latter is applied, especially in the treatment of inter mittents. 
It is, however, much inferior to quinine. 

Salicin is an excellent stomachic tonic in atonic dyspepsia, and is a 
serviceable remedy to prevent the fermentations which take place in 
the foods in cases of g astro -intestinal catarrh. In the chronic diar- 
rhoea of children, it has been employed successfully. The good results 
obtained from it in these cases are doubtless due to its antiferment 
properties and its lack of irritating qualities. 

The most important use of salicin thus far proposed is in the treat- 
ment of acute rheumatism. Its utility has been zealously maintained by 
Dr. Maclagan, to whom, also, we are indebted for much information in 
regard to its therapeutical properties. He asserts that the more acute 
the case the more beneficial the remedy ; that the good effects are 
always experienced within forty-eight hours; that relief of pain and fall 
of temperature are the earliest effects produced. Maclagan gives from 
ten to thirty grains every two, three, or four hours, in powder mixed 
with water. "Fifteen grains every three hours is a medium dose." 

Much confirmatory evidence has been published ; but, on the whole, 
salicin is generally regarded as inferior to salicylic acid. There are 
conditions of the system, however, in which salicin should be pre- 
ferred to any of its congeners. In those cases characterized by weak 
heart, whether from adherent pericardium, myocarditis, fatty degen- 
eration, or other causes, salicylic acid may be dangerous. Again, 



362 ANTISEPTICS. 

when the vasomotor system is depressed, salicin is far safer. As the 
curative results obtained from salicin are but little inferior to those 
from salicylic acid, whenever the latter is contraindicated, the former 
may be confidently relied on, if efficiently administered. 

Authorities referred to : 

Husemann, Drs. Aug. und Theod. Pflanzenstojfre, p. 959, et seq. 
Maclagan, Dr. T. The Treatment of Acute R/ieumatism by Salicin. The Lancet, 
March, 1876. 

Acidum Salicylicum. — Salicylic acid. Acide salicyliqiie, Fr. ; Sali- 
cylsaiire, Ger. 

Properties. — Salicylic acid crystallizes in needle-shaped crystals, 
which are soluble in alcohol and ether, and in hot but not in cold 
water. It is without smell, and its taste is slight and not disagree- 
able. The solubility of salicylic acid in cold water is increased by the 
presence of neutral salts. Three parts of phosphate of sodium will 
render one part of the acid easily soluble in fifty parts of water. Bo- 
rate of sodium is still more efficient in promoting the solubility of the 
acid, and, as boracic acid has properties corresponding to salicylic, the 
borate should be preferred for this purpose. It has been shown that 
ten parts of salicylic acid can be dissolved in one hundred parts of 
water, by the addition of eight parts of borax (Bose). The borax 
should be first dissolved by the aid of heat, and the salicylic acid 
should be added gradually to the hot solution of borax. On cooling, 
filtration is necessary to separate a small quantity of undissolved 
residue. 

The dose of salicylic acid for internal administration ranges from 
ten grains to one drachm. 

JSodii Salicylas. — Salicylate of sodium. Dose, grs. xv — 3 j. The 
best mode of administration is in the form of wafer, containing five 
to ten grains. These may be given rapidly until the requisite quan- 
tity has been swallowed. Salicylate of soda may be prepared extem- 
poraneously by the addition of salicylic acid to a solution of bicarbonate 
of sodium. If the alkali is in excess, the resulting solution is brown- 
ish or purplish in color, and has a strong odor of wintergreen. This 
is not repulsive to most patients. 

The following is a suitable formula : IJ Acidi salicylici, 3 ij ; sodii 
bicarb., 3 j ; aqua?, § ij. M. Sig. : A teaspoonf ul every two, three, or 
four hours. , 

Antagonists and Incompatibles. — The mineral acids, the me- 
tallic salts, and the preparations of iron in general, are chemically in- 
compatible. From the physiological standpoint, salicylic acid and 
the salicylate of soda are antagonized by the arterial and cerebral 
gtimulants. 

Synergists. — The effects of salicylic acid are increased in all di- 



SALICYLIC ACID, 363 

rections by the members of the phenol group, by the arterial depres- 
sants, and by the anaesthetics and cerebral sedatives. 

Physiological Actions. — In small doses, salicylic acid may stimu- 
late digestion, but in considerable quantity, especially if frequently 
repeated, it causes uneasiness at the epigastrium, nausea, and vomit- 
ing. This inability of the stomach to dispose of the large doses of 
salicin, salicylic acid, and salicylate of soda, required in the treatment 
of certain diseases, is an obstacle to their use. They are diffusible and 
readily enter the blood. It is in a high degree probable that salicylic 
acid combines with an alkaline base and enters the blood as a salicyl- 
ate — as a salicylate of sodium, according to Salkowsky. Binz holds 
that the free carbonic acid present in the blood must effect the separa- 
tion of salicylic acid from its combinations, and hence that salicylate 
of soda must act as salicylic acid. It is well known, of course, that 
salicylate of soda does not possess the antiseptic property of salicylic 
acid, and, as both act similarly after their medicinal administration, it 
seems highly probable that the decomposition just mentioned does 
actually take place. An observation of Kohler seems to support the 
theory of Binz. Kohler found that, while ordinary blood containing 
salicylic acid did not yield it up to ether, the blood of asphyxia, which 
contains an exceptional quantity of carbonic acid, did yield up its 
contained salicylic acid to ether. The blood in the vessels unques- 
tionably contains more carbonic acid than that which has been exposed 
to the air. Salicin, as Senator first demonstrated, under the action of 
ferments, splits up into saligerine and glucose, and saligerine is readily 
oxidized into salicylic acid. This process is supposed to occur in the 
body, and hence the comparative slowness of action of salicin an. c 
similarity in its effects to salicylic acid. Spencer, examining the blood 
of a person taking salicin, only got evidence of the presence of the 
glucoside but not of the salicylic acid, and in the urine of the same 
subject found but a small part of the acid which ought to have ap- 
peared, whence he concludes that the conversion of salicin into sali- 
cylic and salicyluric acids, according to Senator, is but partially accom- 
plished in the organism. These observations adequately explain the 
superior activity of salicylic acid as compared with salicin. 

In health, ordinary doses of salicylic acid and salicylate of sodium 
have but little effect on the circulation. In the carefully conducted 
experiments of Ringer and Morshead, made on normal subjects, con- 
siderable doses of the acid increased the pulse-rate from ten to twenty 
beats, but more or less feverish ness was produced by the irritant ac- 
tion on the gastro-intestinal mucous membrane. The manometric 
studies of Kohler demonstrated that this agent lowers the blood-press- 
ure, and this result occurred after division of the vagi, the depressors, 
and the spinal cord, whence it must be concluded that it accomplishes 
this result by a direct action on the heart and vaso-motor ganglia. 



364 ANTISEPTICS. 

More recent observations by Oltramare show that when salicylic acid 
is thrown into the veins the first effect is to increase the energy of the 
systolic contractions, the number of pulsations, and the blood-pressure. 
These effects, he finds, are due to a direct stimulation of the heart and 
of the motor centers. Under the influence of increasing doses, the 
vessels dilate, the blood-pressure falls, and finally the heart is arrested. 
There is, therefore, a general agreement as to the increase of the ac- 
tion, lowering of the blood-pressure, etc., as studied in animals, and 
observed on man by Ringer and Morshead. Professor See, however, 
fails to discover any effect by salicylic acid on the heart or blood- 
pressure, but, as he administered the remedy by the stomach, it is 
probable that he did not secure admission to the blood of a sufficient 
amount. 

The numerous observations made on the effect of salicylic acid and 
salicylates on the heat-function are in close accord. In health it is 
found that, unless toxic doses are taken, the temperature is but slightly 
or not at all affected. Riess, one of the first to make observations on 
this point, noted a constant reduction of the normal temperature ; but 
See, Ringer, Fiirbringer, and others, agree that in health this agent 
does not affect the temperature. Riess's conclusions were based on 
more than four hundred observations of the internal use of salicylic 
acid, and in twenty-three cases he ascertained a reduction of 1*6° 
Fahr., produced by five grammes (nearly eighty grains). If fever is 
present, whether produced artificially by the injection of septic ma- 
terials, or arising spontaneously, salicylic acid very uniformly effects 
a considerable reduction. The result, however, is not always the same, 
fc salicylic acid has a decided antipyretic action is denied by Zini- 

rmann, Wolffberg, and some others ; but the weight of testimony 
is overwhelmingly the other way. It is certain that the degree of 
antipyretic effect varies in different forms of fever (Bartels, Senator, 
Nathan, and others), and also according to the individual susceptibility 
to its action. The phenomena attending the reduction of temperature 
are worthy of consideration. At the onset of the action, in ten to 
fifteen minutes after the dose is swallowed, some increase in the heart's 
action, a feeling of warmth through the system, and flushing of the 
face with suffusion of the eyes are experienced, then the perspiration 
begins, appearing first on the face, then on the chest, abdomen, and 
extremities, and presently becomes profuse. Coincidently with the 
sweat, the decline in temperature begins, but it continues after the 
sweating. There is no ratio between the amount of sweating and the 
reduction of fever-heat, for with much sweating there may be but 
slight diminution in the temperature, and with little sweating a marked 
decline. In febrile cases the decline of temperature varies from 1° to 
6° Fahr. (Riess, Nathan, Bartels, Ewald, and others). The quantity 
of salicylic acid necessary to effect any considerable reduction of tern- 



SALICYLIC ACID. 365 

perature ranges from one to two drachms. The effect is maintained 
from five to twenty hours, when a repetition of the dose usually be- 
comes necessary. With the first effect of the agent on the heart, the 
pulse rises, but, as the sweating progresses, more or less slowing of the 
heart-beat occurs. There are differences of opinion, however, on this 
point. Thus, Ewald, Riess, Goltdammer, and a few others, hold that 
the pulse is little if at all affected ; but the usual expression is that, 
after a preliminary rise, there ensues with the perspiration and lower- 
ing of the temperature a marked decline in the pulse-rate (Buss, Star- 
gard, Nathan, Moeli, etc.). 

With the first impression of this agent on the respiratory center, 
the number of respirations is increased, but, with the decline of tem- 
perature and of the pulse, they are lessened. The excretion of car- 
bonic acid, Livon shows, is the greater, the larger the dose of salicylic 
acid, estimated during the period of increased action of the lungs. 
Under the influence of large doses, accumulation of the acid takes 
place in the cerebro-spinal fluid, causing an excitation of the roots of 
the pneumogastric nerve, but the excitation is succeeded by the de- 
pression which terminates in arrest of the respiratory function. 

As the effects of salicylic acid or salicylate of sodium develop, more 
or less headache, with a feeling of distention and frontal oppression, is 
experienced. Buzzing in the ears, dullness of hearing, and even deaf- 
ness, are usual symptoms when the doses are large. Vision is also 
affected, the sight becoming dim, or strabismus or ptosis occurs. In 
one case sudden and complete amaurosis came on (Gatti) after the ad- 
ministration of one hundred and twenty-five grains of salicylate of 
soda ; the pupils were widely dilated, the sclerotic and cornea acquired 
extreme sensibility, but the retina was unchanged, and the vision for- 
tunately was restored after ten hours without impairment. In other 
cases, subacute delirium, or delirium with refusal of food, and various 
delusions (Daly) have occurred while patients were taking consider- 
able doses. Ordinarily, however, the cerebral effects of salicylic acid 
are not unlike those of quinine. The state of the intracranial circula- 
tion which it induces has not been studied. According to Blanchier 
and Rochefontaine, salicylate of soda depresses the functions of the 
central nervous system, but the irritability of both sensory and motor 
nerves and the contractility of muscle remain unimpaired. 

Animals to whom salicylate of sodium is administered daily for 
some time, emaciate rapidly (Chirone and Petrucci). The toxic dose 
for the dog, ass, and horse, according to Oltramare, is one gramme 
per kilogramme of the body-weight. Death is due to paralysis of the 
heart, and not from asphyxia, as has been heretofore supposed (Oltra- 
mare). After death the abdominal viscera are intensely congested, 
unless the medulla be divided, when a marked degree of anaemia suc- 
ceeds to the hyperemia. It is this fact chiefly which induces Oltra- 



366 ANTISEPTICS. 

mare to maintain that salicylate of sodium acts on the vaso-motor 
center in the medulla. 

On man as well as on animals sometimes salicylic acid produces se- 
rious symptoms. The intoxication, with delirium and delusions which 
it causes in certain subjects, especially those suffering from acute rheu- 
matism, has been referred to. In drunkards it is especially apt to act 
unfavorably, bringing on in them violent delirium. In rare instances 
salicylic acid and the salicylates have induced a condition of collapse, 
with restlessness, delirium, great dyspnoea, feeble pulse, and involun- 
tary evacuations. The vaso-motor paresis, which is a result of large 
doses in feeble subjects, may be accompanied by great relaxation of 
the skin, the rapid formation of bed-sores, etc. Dr. Tuckwell, of the 
Radcliffe Infirmary, Oxford, gives the following symptoms as occur- 
ring in two cases under his observation : " Loud, deep, and sighing res- 
piration ; a strange restlessness, gradually increasing to delirium, and 
not unlike that of delirium tremens, with involuntary evacuation of 
urine and fseces in the worst of the two cases ; a slow and laboring 
pulse ; an olive-green color of the urine." No fatal case, distinctly 
due to these preparations, has been reported, but many have occurred 
in which very dangerous symptoms arose ; but, fortunately, all dis- 
appeared on stopping the administration of the remedy. The existence 
of albuminuria is an important factor in the causation of bad results 
(Huber). 

The rate of diffusion of salicylic acid has been closely studied by 
Blanchier and Rochefontaine, with the following results : When in- 
jected into the veins of a dog, salicylate of soda appeared in the saliva 
in four to five minutes ; in the urine, eight to ten minutes ; and in the 
bile and pancreatic secretion, in fifteen to twenty minutes. When 
taken into the stomach, it appeared in the saliva in twenty minutes, 
and in the urine in forty- five minutes. In man salicylic acid is ex- 
creted chiefly, almost wholly, by the kidneys, and appears in the urine 
in twenty minutes after it is taken into the stomach. It is excreted 
as salicyluric acid, which may be seen as a deposit at the bottom of 
the vessel, "of a white, feathery consistence." The urine presents a 
more or less deep greenish tint. The presence of the acid is readily 
ascertained by the solution of chloride-of-iron test. To the urine sus- 
pected to contain salicylic acid, add slowly, drop by drop, the chloride- 
of-iron solution ; phosphate of iron is first formed, which is whitish in 
color, but presently, if salicylic acid be present in a free state, a violet 
color is developed. The urine, during a course of the acid or of the 
salicylates, frequently contains albumen, due, doubtless, to the irrita- 
tion of the kidneys as elimination is going on. The facts do not yet 
warrant any conclusion in regard to the damage which may be perma- 
nently inflicted on the kidneys by the prolonged administration of this 
agent. The influence over the urinary excretion has been examined 



SALICYLIC ACID. 367 

by Bouchard. There is reason for believing that the urinary water 
is not augmented, the extractives are somewhat increased, and the 
phosphates and coloring-matter are unchanged. Prof. See finds that 
the excretion of uric acid in gouty cases is promoted. It is main- 
tained by others that the amount of urea present in the urine is greater 
than normal. Livon and J. Bernard have ascertained that salicylic 
acid, after being thrown into the stomach or into a vein, appears with- 
in an hour or two in the saliva, milk, pancreatic secretion, bile, as well 
as urine, and it was always found in the cerebro spinal fluid. They 
conclude that it acts locally at these points of contact with the struc- 
ture of organs. Hence, it appears highly probable that the local stimu- 
lation increases the product of those glands through which the acid 
or its salt passes, but not in the urine, if Bouchard's observations can 
be relied upon. Albuminuria, according to Gubler, is produced by it 
in some cases, and temporary impotence has been observed in others. 

Therapy. — The applications of salicylic acid in the treatment of 
disease are based on the results of the physiological examination. In 
the diseases of the stomach characterized by fermentative changes in 
the food, as in catarrh, dilatation of the organ, etc., salicylic acid is 
an effective remedy. The author has seen admirable results from its 
use in gastralgia, even when distinctly periodical. In the vomiting 
of a pasty, fermenting mass of ingesta, whether or not accompanied 
by the organism, sarcina, or other germs of fermentation, good results 
are derived from this remedy. In these stomachal disorders, the best 
effects are had from ordinary doses (five to ten grains), given in a 
wafer, either in anticipation of the attack — as of gastralgia appearing 
at a fixed hour — or during the process of fermentation in the stomach 
contents. As a portion of the remedy taken passes into the faeces, it 
is probable that salicylic acid is just as effective in the corresponding 
troubles in the intestines. Ilgin reports the removal of twnia solium 
in six cases by the administration of salicylic acid, in eight-grain doses 
every hour until five doses were taken — preceding and following the 
acid with a dose of castor-oil. It has been employed successfully in 
the removal of ascarides, by local application and by internal adminis- 
tration. An enema of water should precede the salicylic-acid solution, 
which may be composed of borax and salicylic acid with some gly- 
cerin. $ Acid, salicylic, 3 ss ; sodii biborat., 3 ss ; aquae, Oj. M. 
Sig. : Warm, and administer the whole amount at one time. For a 
young child, this quantity should be reduced one half, or more. 

When the heart is weakened from any cause, salicylic acid and 
salicylate of soda must be exhibited with caution. The experience 
thus far accumulated warrants the assertion that the dose of fifteen 
grains of the former and twenty of the latter should rarely be ex- 
ceeded, if frequent repetition of the dose is practiced. From Riess, 
who regards salicylate of soda as a specific in typhoid fever, to Filatow, 



368 ANTISEPTICS. 

who holds that it is worse than useless, there are various shades of 
opinion, with the weight of authority decidedly in favor of the view 
that it is a remedy of real value. Since Riess, no one has claimed in 
this remedy a specific for typhoid, but it is generally admitted that it 
renders the course of the disease milder by keeping the temperature 
within safe limits (Tomkins, Hallopeau, Butt, Immermann, Senator, 
etc.). Weiss concludes, after an experience of ninety-six cases of ty- 
phoid in children, treated with salicylate of soda, that it is a powerful 
antipyretic in the typhoid of children, and that, while it does not 
shorten the course of the disease, it renders it much milder. He finds 
that the results are better, when the typhoid of children is treated by 
salicylate of soda, than have hitherto been obtained from quinine and 
cold baths. A still more recent English experience is to the same pur- 
port as the German. Dr. Tomkins finds that in the salicylates we 
have the means of reducing fever-heat, more certain and more agree- 
able than by the cold bath. In the eruptive fevers, the same prin- 
ciples obtain as in typhoid. Salicylate of soda is preferable to sali- 
cylic acid, because it is less irritating, safer, and equally effective as 
an antipyretic. The object of its administration is to reduce the heat, 
which is the most important source of danger. The amount required 
to accomplish this object is now definitely known. Twenty grains of 
the soda salt may be given every two hours, until the temperature is 
reduced to the proper point, at which it may be held by ten-grain 
doses at the same interval, unless the occurrence of an exacerbation 
requires the exhibition of a larger quantity. In the case of children, 
the daily quantity ranges from half a drachm to a drachm. Probably 
the best mode of administering the salt is in the form of wafer, but 
when these can not be obtained, a solution may be readily prepared, 
or the salt may be constructed extemporaneously by adding the acid 
to a solution of sodic carbonate as follows : fy Acid, salicylic, 3iv ; 
sodii bicarbonat., 3 j ; aquae, § jss ; syrup, simpl., § ss. M. A table- 
spoonful contains about twenty grains salicylate of soda. It should be 
borne in mind that this remedy is not safe if the heart is very weak, 
or if albuminuria is present. 

In relapsing fever, according to Riess, salicylic acid accomplishes 
something more than the mere reduction of temperature. Although 
it does not prevent the usual relapse, even when administered in large 
doses during the interval, it lessens the severity and duration of the 
relapse. It does not destroy the spirilla in the blood, nor indeed 
lessen their activity (Riess), and hence can not be a curative agent in 
this disease. In pyaemia, septicemia, puerperal fever, diphtheria, 
etc., salicylate of sodium is used under the same rules as in typhoid. 
The indication for its use is high fever, and the good accomplished by 
it is determined by the degree in which the temperature is reduced. 
The antiseptic action is quite secondary to the antipyretic. In mala' 



SALICYLIC ACID. 369 

rial fevers it was supposed by Senator and others, in the enthusiasm 
attending the introduction of the remedy, that salicylic acid would 
prove equal to quinine. If administered in a full dose just before the 
advent of a paroxysm, it will prevent it, but it does not possess the 
curative powers of quinine over the effects of the malarial poison, and 
hence will not prevent relapses. By using salicylate of sodium to 
abort an impending paroxysm, and quinine to prevent relapses, the 
curative result will be attained with the least pecuniary expenditure. 
In the mildest cases of intermittents, salicylate of sodium may be de- 
pended on alone, but, to succeed, it must be administered before the 
expected paroxysm. 

Out of the enormous mass of published experience in regard to the 
value of salicylic acid in acute rheumatism, it is difficult to select. 
From the first trials of Buss, followed by Strieker and Traube, there 
has been an almost unanimous expression of opinion by the German 
physicians in regard to the value of this agent in rheumatism. At 
first it was supposed that the disease could be invariably cut short in 
forty-eight hours to three days, but larger observation has qualified 
these opinions. By way of illustration of the measure of success now 
attained in Germany with salicylic acid in rheumatism, we may take 
the recently published statistics of Diesterweg. Of one hundred cases 
treated with this remedy, the disease was cut short in thirty-six or 
twenty-four hours ; in eighty-five, within the period of forty-eight 
hours ; in ninety-eight, within seventy-two hours ; in one the disease 
was prolonged to eighty-four hours ; and in one the remedy had no 
effect on the disease. It is not intended to convey the impression that 
the cases got well in so short a time, only that the fever and joint- 
swelling and pain subsided, and convalescence was established. Re- 
lapses occurred in eleven cases, and cardiac complications in five. 

In France the treatment of acute rheumatism by salicylic acid was 
taken up by Jaccoud, Lepine, Gueneau de Mussy, and others, but es- 
pecially by Prof. See, who has devoted to it several important lectures. 
As a result of See's observation, he concludes that salicylic acid has a 
marked and peculiar benefit in acute rheumatism ; that the pains in- 
variably cease in from twelve to eighteen hours ; that the articular 
swelling disappears at the end of three days, and that the fever sub- 
sides with the pains. If the fever persists, other joints will become 
affected. Out of fifty-two cases treated by Prof. See, fifty-one recov- 
ered in from two to three days. These results are quite equal to the 
German. See makes an important observation in regard to the ra- 
pidity with which salicylic acid and salicylate of sodium are eliminated, 
and the necessity, therefore, of continuing the remedy for some time 
after all the joint-troubles have ceased, to prevent relapses. Prof. 
Gubler does not share the general enthusiasm as to the value of 
this agent in rheumatism. He emphasizes the uncertainty and the 
25 



370 ANTISEPTICS. 

dangers attending its use, and maintains that it has no antipyretic 
effects. 

In England salicylic acid and salicylate of sodium have been used 
with a large measure of success, but the rheumatism of England, as of 
this country, does not yield with the promptness characteristic of the 
Continental disease. The general results of the treatment, as con- 
ducted in England by Broadbent, Carafy, Spencer, Boggs, Greenhow, 
and many others, is very much as expressed by the last-named in his 
important communication to the Clinical Society. The temperature 
speedily falls, sometimes within a few hours and almost always in two 
or three days, the pulse declines at the same time, the pains subside 
correspondingly, and the joint-swelling diminishes and disappears 
within three or four days. Greenhow points out that such a result is 
not a cure even in the most favorable cases ; that the remedy acts 
very injuriously on the heart and causes a deep anaemia, and that, 
therefore, the duration of the disease, from beginning to the termina- 
tion, is not actually shortened. Dr. Maclagan (also Charteris) strongly 
urges the substitution of salicin, on the ground that it is equally effec- 
tive with salicylic acid and much less dangerous ; but it is difficult to 
appreciate this argument, since salicin is converted into salicylic acid 
in its passage through the system. 

In this country, the experience of the Maine physicians, and of the 
medical staff of the Massachusetts General Hospital, has been pub- 
lished, and all concede that it has good effects. As regards the ex- 
perience at the Massachusetts General Hospital, the facts are as follows : 
In eight cases out of seventeen treated with salicylic acid, the duration 
of the longest case was twenty-six days, and the shortest five days, 
the improvement being very marked from the beginning of treatment. 
Of three patients who took salicylate of soda only, the duration of the 
disease was less than twelve days in each case, the shortest being two 
days. In the remaining nine cases the duration was six weeks or more. 

In summing up the testimony, it is clear that salicylate of soda is 
a most valuable remedy in acute rheumatism, but various unpleasant, 
even dangerous symptoms arise in some cases. Violent headache, ver- 
tigo, and tinnitus aurium, are common ; wild delirium is an occasional 
symptom ; weakness of the heart, obscuration of the first sound, and 
profound anaemia, are especially noted by Greenhow ; very great gas- 
trointestinal disturbance is now and then produced. Empis narrates 
a fatal case of acute rheumatism which was treated by salicylic acid. 
Great depression of the powers of life, in rare instances approaching 
collapse, has been observed. Sufficient is now known of the danger 
attending the salicylic medication of acute rheumatism, to justify the 
author in urging circumspection on the attention of his readers. The 
robust and vigorous rheumatics are proper subjects for this treatment, 
whereas, in the pale, feeble, and cachectic, especially those with weak 



SALICYLIC ACID. 371 

hearts, this treatment must be pursued cautiously, or not undertaken 
at all. Relapses are frequent, probably because of the very rapid 
elimination of the remedy, as suggested by Prof. See, and hence its 
administration must be continued for some time after all of the local 
and systemic symptoms have subsided. 

In gout, chronic rheumatism, myalgia, and lumbago, salicylate of 
sodium often acts most serviceably. It is more effective the more 
acute the malady, as a rule, but it sometimes does great good in the 
most chronic cases. Abbott reports the cure of sciatica, and Brun of 
rheumatismal irido-choroiditis, by its use. The author has succeeded 
in some instances very promptly in the cure of sciatica by the salicy- 
late of soda — the formula used being that for the extemporaneous so- 
lution. The cases in which this remedy has proved most efficacious, 
were those of functional disturbance in the nerve, the muscles being 
in their normal condition, and the pain having nocturnal exacerbations. 

It is a very interesting fact, first distinctly stated by Dr. Pye 
Smith, of Guy's Hospital, London, that, during the administration of 
salicylic acid and the salicylates, the urine exhibits the reaction for 
sugar on the application of Trommer's test. This has been observed 
in rheumatism and in other diseases treated with this agent. The 
urine is a little increased in amount, but its specific gravity is not 
changed. The reduction of the copper is effected by the acid or by 
the glycogen, which is one of the products of the decomposition of 
salicylic acid. Mtiller, the assistant of Eckstein in the clinic at Kiel, 
has published some important observations on the use of salicylate of 
soda in the treatment of diabetes. It appears that full doses of the 
salt cause the sugar to disappear entirely, but this is not a permanent 
result, for, after a time, the sugar returns. A very great tolerance to 
the remedy exists in this disease, and large doses may be taken with 
impunity. Bouchardat, in commenting on these observations, states 
that he has not had good results from this treatment. Since, however, 
the remedy is well tolerated, and during its exhibition in considerable 
doses the sugar disappears, it may be used with advantage at critical 
times to stop the waste. 

Salicylate of sodium has feeble antiseptic properties, and hence 
salicylic acid, which is even superior to carbolic acid in its power to 
destroy minute organisms and to prevent change in putrescible mate- 
rials, should be preferred for all topical applications. Being free from 
odor, and more active than carbolic acid, it should be used instead 
of carbolic acid for most purposes. For all toilet purposes, it is decid- 
edly preferable. It is an excellent addition to the ordinary powder 
dentifrices, and its solution with borax is an efficient deodorant in fetid 
perspiration. This disagreeable affection, as it attacks the feet, may 
be relieved by dusting the feet thoroughly with powdered salicylic 
acid before putting on the stockings. It is useful, also, to fill the in- 
terstices of the stockings with the powder. Extraordinary success has 



372 ANTISEPTICS. 

been achieved by the local application of this remedy in eczema of the, 
head and face. Those cases characterized by mnch weeping seem to 
be best adapted to the cure by salicylic acid, but eczema rubrum and 
eczema impctiginodes, that resisted other approved means, have yield- 
ed to the application of this agent (Wagner, Will). It is generally 
conceded that, as a local application to syphilitic ulcers, salicylic acid 
is inferior to carbolic acid. 

The most important of the topical uses of salicylic acid are in the 
antiseptic treatment of wounds and injuries. When it was shown that 
this agent had a power to destroy the activity of ferment and disease- 
germs equal to that of carbolic acid, while it is free from the irritating 
quality and disagreeable odor of the latter, Thiersch, who is a strong- 
advocate for Lister's antiseptic method, resorted to the use of salicylic- 
acid solutions. Further experience has, however, rather proved the 
superiority of carbolic acid in respect to the germicide and antiseptic 
properties for which these remedies are now so largely employed. 

To cancer, gangrenous and sloughing wounds, pure salicylic acid 
may be applied in powder. To prevent the contact and multiplication of 
atmospheric germs, operative procedures may be conducted in salicylic 
spray, the sponges and dressings may be saturated with salicylic solu- 
tions, and the wound irrigated by the same. In order to carry out all 
the details of the antiseptic method, salicylic acid is substituted for car- 
bolic in the forms and combinations of dressings employed by Lister. 
Wounds are covered with cotton-wool, impregnated with an alcoholic 
solution of the acid in the proportion of 3 and 10 per cent. As cold 
water takes up only 1 part to 300, which, however, is strong enough 
to destroy bacteria, etc., the addition of borax is generally necessary 
to obtain a solution of sufficient strength for the antiseptic applications. 
A salicylic-acid plaster may be prepared as follows : Salicylic acid, 
3 ss — 3 j; white wax, 3j ; paraffin, 3 ij ; almond-oil, 3 ij. The in- 
gredients are melted, and rubbed up together in a heated mortar 
(Will), and spread on muslin. An ointment more readily melted by 
the heat of the body is the following : sperm-oil, 3 jss ; cacao-but- 
ter, 3 vss ; salicylic acid, 3 ss — 3 j. This should be melted together, 
thoroughly incorporated, and spread on lint (Will). An ointment 
for the same purposes may be prepared in a simpler way by the ad- 
dition of salicylic acid to simple cerate. A solution of salicylic acid 
in olive-oil, in the proportion of one drachm to eight ounces, is an 
efficient local application for burns. 

Authorities referred to : 

Bose, Dr. H. Berliner Hinisclie Wochensch?'ift, 1875, No. 28. 

Buss, Dr. E. Die antipyretische Wirkung der Salicyhaure. Cent. f. d. med. Wissen- 
schaften, 1875, No. 18. 

Furbrixger, Dr. Zur Wirkung der Salicyhaure, pamphlet, Jena, 1875. 

Immermaxn, Prof. Quoted in Liebcrmeister's Handbuch der Pathologie und Tlierapie 
des Fiebers, Leipzig, 1875, p. 644. 



PHENOL AND CHINOLINE DERIVATIVES. 373 

Kolbe, Prof. Ueber die antiseptischen Eigenschafter der Salicylsaure. Schmidt's Jahr- 
bucher, vol. clxiii, p. 229. 

Lbtzerich, Dr. Ludwig. Ezperimentellen Untersuclmngen und Beobachtungen iiber 
die Wirkung der Salicylsaure bei der Diphtherie. VirchovPs Archiv, Band lxiv, p. 102. 

Moeli, Dr. Berliner klinische Wochenschrift, 1875, No. 30. 

Senator, Prof. Dr. Berliner klinische Wochenschrift, No. 32. 

Squibb, Dr. E. Note on Salicylic Acid, Brooklyn, 1875. 

Thiersch, Prof. Dr. Klinische Ergebnisse der Lister 1 'schen Wundbehandlung, etc. 
Volkmann's klinische Vortrage, Nos. 84 and 85. 

Traube, Dr. L. Berliner klinische Wochenschrift, No. 1, 18*76. 

Will, Dr. J. C. Ogilvie. On Salicylic Acid. The Lancet, vol. ii, 18*75, p. 870, et seq. 



PHENOL AND CHINOLINE DERIVATIVES. 

Resorcin. (Not official.) 

History. — Resorcin is a chemical compound, discovered by Hlasi- 
wetz and Barth, and was obtained from certain resins by the action of 
fusing alkalies. They assigned to the new compound the name resorcin, 
partly because it is derived from a resin, and partly because it has 
some similarity to orcin, a peculiar substance obtained from archil. 
Subsequently resorcin was constructed synthetically by Korner, and 
at the present time it is obtained in various ways, the product being 
both pure and cheap (Andeer). 

Properties. — Resorcin is a member of the phenol group. It oc- 
curs in tabular prismatic crystals, rather shining and lustrous, some- 
what sweetish to the taste, with a little after-pungency. When struck 
or rubbed in the dark, it appears phosphorescent. In odor it is some- 
what like phenol, but not nearly so pronounced. It is freely soluble 
in water, in the proportion of 86*4 parts of resorcin to 100 parts of 
water at 0° C. It is dissolved by all liquids except chloroform and 
carbon sulphide. Aqueous solutions exposed to the air and light, as- 
sume a more or less brownish tint, but without any apparent change 
in quality. Albuminous liquids treated with a concentrated solution 
of resorcin, become turbid by the formation of an albuminate of resor- 
cin. Various secondary products are obtained from it by the action 
of chlorine, iodine, bromine, nitric and nitrous acids, etc. In the pro- 
cess by which resorcin is produced, are also hydroquinone and pyrocate- 
chin. The best vehicles, according to Andeer, are alcohol, glycerin, 
and sirup of orange. The dose for usual purposes ranges from five to 
fifteen grains. For a decided antipyretic effect a drachm may be 
given, but this amount could not be frequently repeated. Five 
grains may be given every two hours, in an ordinary case. 

Antagonists. — From the physiological standpoint, resorcin is an- 
tagonized by the cerebral excitants, by the agents which raise the 
arterial tension, and by the cardiac and respiratory stimulants — by 
atropine especially. 



374 ANTISEPTICS. 

Synergists. — Its effects are promoted by quinine, salicylic acid, 
carbolic acid, etc. 

Physiological Actions. — Resorcin does not irritate, nor is it ab- 
sorbed by the unbroken integument. The solution injected into the 
subcutaneous tissues produces but little irritation, and never inflam- 
mation and abscess. Applied to the moistened mucous membrane, it 
causes vesication, and a white blister forms, like that from carbolic 
acid. It has decided anti-ferment properties, arrests decomposition in 
animal tissues, deodorizes, and is destructive of the minute organisms 
on the presence of which putrefactive decomposition is dependent. A 
one-per-cent solution will prevent the decomposition of urine when 
exposed to the air for months (Andeer). Applied to unhealthy wounds, 
it arrests the decomposition, destroys the fetor, and promotes healthy 
cicatrization (Dujardin-Beaumetz). 

The action of lethal doses is necessarily to be studied on animals. 
Murrell has, it is true, given a good account of the symptoms produced 
by an overdose, but the details can be obtained only by experiments 
on animals. Soon after the administration of a full dose — thirty cen- 
tigrammes (about five grains) of resorcin per kilogramme (about thirty- 
five ounces) weight of the animal experimented on — trembling begins, 
due to fibrillary contractions of the muscles, and this passes into gen- 
eral clonic convulsions of an epileptiform type. These convulsions 
regularly increase in severity, and, reaching their maximum in a few 
minutes, as regularly decline, the whole duration of this phase of the 
action being about two hours, sometimes longer. The spinal cord is 
doubtless the seat of the action, since the irritability of the peripheral 
nerves and muscles is diminished only, and not entirely destroyed. 
The general sensibility is preserved, whence it must be concluded that 
the action of resorcin is on the motor elements (Callias). The blood 
seems not to be altered in respect to its composition or properties ; it 
presents a normal appearance, coagulates in the usual manner, and the 
venous blood, exposed to the air, assumes the proper red hue. 

The lethal dose, according to weight, is ninety centigrammes per 
one kilogramme. The phenomena observed when such a dose is ad- 
ministered are the same as those above sketched, except that sensibility 
is impaired as well as motility. 

Resorcin, through the action on the nervous system, affects the 
respiration and circulation when the dose is large. At first the respi- 
ration is greatly increased in frequency, becomes convulsive and jerk- 
ing, and afterward shallow and weak but rapid. The action of the 
heart also becomes rapid, the pulse weak and somewhat irregular, but 
the respiration ceases before the action of the heart. The temperature 
rises, and just before death attains to 103° to 105° Fahr. This increase 
of the body-heat is doubtless correctly attributed to the extreme mus- 
cular action (Dujardin-Beaumetz), and not to irritation of a hypo- 



RESORCIN. 375 

thetical heat-center. Resorcin, which acts in many respects so like 
quinine, however, differs from this agent remarkably in respect to the 
lethal effects. 

When a considerable dose of resorcin (thirty to sixty grains) is 
administered to a person in a fever, in a few minutes a sense of heat 
is felt about the epigastrium, and spreads thence over the system ; the 
face flushes and grows hot, the eyes glisten, the breathing and pulse 
are accelerated, and dizziness, with ringing in the ears, and frontal 
headache, are experienced. A good deal of discomfort, oppression of 
the chest, and a sense of distention of the head, are usually produced, 
but these sensations subside in from ten to fifteen minutes, the skin 
then grows moist, and in a few minutes more a profuse perspiration 
is pouring out on the surface of the body. The pulse then falls, cool- 
ness succeeds to heat, languor to tension, and the temperature of the 
body declines several degrees. If the feverish state has no special 
features, the lessening of the pulse and reduction of temperature to 
the normal occurs in about an hour. The pulse may be slowed one 
third, and the reduction of temperature be as much as three or more 
degrees of Centigrade or five degrees Fahr. (Lichtheim). The reduc- 
tion of temperature in fever is of comparatively brief duration, lasting 
from two to four hours. When the rise of temperature begins again, 
a sense of chilliness is experienced, which may even take the form of 
a distinct rigor. Lichtheim observed great differences in the power 
of resorcin in different fevers. The less the tendency to spontaneous 
remissions, the less the antipyretic effect. The fever accompanying 
pneumonia and erysipelas was less amenable to the action of resorcin 
than was typhoid fever, but no form of fever entirely resists its action. 
In the normal, the action on animals and on man corresponds closely. 
The correspondence also exists in respect to the action in pathological 
states, as above stated. To the information thus obtained may be 
added the experiences on healthy men, as furnished us by Andeer, by 
Baumann and Preusse, Fauber, and others. In small doses, the circu- 
lation, respiration, and temperature are but little affected. Andeer, 
from a dose of ten grammes (one hundred and fifty-five grains), suf- 
fered from dizziness, confused vision, deafness, considerable salivation ; 
presently extreme vertigo and loss of consciousness occurred, and then 
general clonic convulsions and tetanic rigidity of the muscles of the 
neck came on. There was no decline of temperature. All of the 
effects subsided in five hours. The preliminary stage of excitement 
produced by resorcin is often accompanied with excitement and de- 
lirium. In one case a deep stupor ; in others, muscular trembling and 
incoherence of speech were observed. 

The elimination of resorcin takes place almost entirely by the 
urine, and it is effected quite rapidly, for the greater part absorbed is 
excreted in an hour. The state of the kidneys, therefore, must influ- 



376 ANTISEPTICS. 

ence the rate of elimination, and correspondingly the duration of the 
physiological or therapeutical actions. The tests for ascertaining the 
presence of resorcin are not sensitive for small quantities. The most 
easily applied is the solution of perchloride of iron, which causes, 
when resorcin is present, a deep violet, almost black, color. 

Theeapy. — A close correspondence exists in the therapeutical ap- 
plications of the members of the phenol group, and Lichtheim traces 
a distinct parallelism between their anti-fermentative and antipyretic 
action. Resorcin, having much less irritating property, is generally 
preferable to carbolic acid for internal and for subcutaneous use. In 
catarrh of the stomach, gastralgia, ulceration, and fermentative indi- 
gestion, Andeer reports on a series of three hundred cases in which it 
acted most favorably. He prescribed chiefly a three-per-cent solution. 
In fevers it has been given with a view both to its antiseptic and anti- 
pyretic actions. It is not a specific, and is only serviceable in the ratio 
in which it reduces heat. In erysipelas, puerperal fever, septicaemia, 
and diphtheria, resorcin may exert an antiseptic effect. For the same 
reason it may be applied to the treatment of ulcerative endocarditis, 
but in intermittent fever, in which considerable success has been 
achieved, it remains inferior to the cinchona alkaloids, although com- 
ing nearer to these remedies than any other in curative power. 

Resorcin has been used by Dujardin - Beaumetz, Andeer, and 
others, with great success locally in syphilitic and other sores of an 
unhealthy or sloughing character. Its solution may be applied as 
spray in affections of the nose and throat, catarrhal, idcerating, or 
specific. Andeer finds it useful in diphtheritic affections and in 
anthrax. The later experiences have confirmed the original reports. 
It is applied freely as powder by insufflation, and, as it has very 
slight causticity, no ill result follows, and a powerful germicide action 
takes place. 

Phenoresorcin. — By the term phenoresorcin is meant, by River- 
din, a mixture of carbolic acid and resorcin : sixty-seven parts of the 
former and thirty-three parts of the latter. This mixture crystallizes 
by cooling, and on the addition of ten per cent of water becomes 
a liquid which mixes with water in all proportions. Combining thus 
the virtues of both remedies, phenoresorcin offers many advantages, 
and may well repay more elaborate investigations. 

Hydroquinon and Pyrocatechin ; Kairine and Kairoline ; Chino- 
line. — In the search for an artificial quinine, produced by a syntheti- 
cal process, various substances, more or less closely related, have been 
formed. Of these, hydroquinone and pyrocatechine are very similar 
in all respects to resorcin. They correspond in physiological actions, 
and have the same power to depress febrile temperature. They are 
also closely allied to quinine chemically, and possess distinct antiperi- 
odic power. When first produced, they were proposed as substitutes 



CHINOLIN. 377 

for quinine ; the close chemical relationship was supposed to imply 
an equally close physiological affinity. Further studies have shown 
that, while these agents are very useful, they are inferior in all respects 
to quinine. Hydroquinon and pyrocatechin are very closely allied to 
resorcin. 

The actions of kairin, hydroquinon, etc., have not proved satisfac- 
tory, and so much depression has been caused by them as to be dan- 
gerous. The more recent and manageable remedies, considered fur- 
ther on, have now displaced them entirely. 

Kairin is a powder having a pale buff color, is slightly soluble in 
water, and has a bitter, somewhat aromatic, and, to most persons, a 
very disagreeable taste. If inclosed in a wafer, which is the most 
agreeable mode of administering it, a quantity of water should be taken 
after it, to prevent the caustic action on the mucous membrane. 

Kairolin is, chemically, methyl-hydride of chinolin. It is very 
much less active than kairin, but the effects when produced are more 
lasting. The dose of kairin, as an antipyretic, is from fifteen to thirty 
grains, given in anticipation of the febrile rise, or it may be admin- 
istered in smaller doses at intervals — for example, five grains every 
hour, until the desired impression is effected. Kairolin, being less 
active by half, must be given in corresponding quantity. 

Chinolin. — So long ago as 1834 this substance was separated from 
coal-tar by Runge, and given the name Leukoline. Subsequently it 
was obtained by Gerhardt from the cinchona alkaloids, and by him the 
name chinoline or quinoline was assigned to it. Lately, chinolin has 
been produced synthetically by Skraup, by acting on aniline or nitro- 
benzol with glycerin in the presence of some dehydrating agent. 
Thus prepared, chinolin is an oily, highly refracting liquid and basic 
substance, which combines with acids to form salts. All of the salts, 
except the tartrate, are very deliquescent, crystallizing with difficulty, 
and soon losing their form ; but the tartrate is in lustrous crystals, 
stable even in a damp atmosphere, and yet sufficiently soluble in water. 
According to Donath, chinolin is not more closely allied to quinine 
in physiological and therapeutical actions than it is chemically. Al- 
though these confident expectations, that in chinolin we have an 
adequate substitute for quinine, have not been realized, this remedy 
is still entitled to be regarded as a valuable antiseptic and antipyretic. 
Donath has shown that a two-per-cent solution will prevent the de- 
velopment of bacteria in decomposing solutions. Its power to reduce 
febrile heat is the same as that of the other agents of the group, except 
that it is greater. Indeed, chinolin is supposed to be nearly as active 
as quinine as an antipyretic. All of these phenol derivatives and con- 
geners — resorcin, hydroquinon, pyrocatechin, chinolin, etc. — possess 
the power to reduce fever-heat, while they are powerless to affect the 
normal temperature. The fall of temperature is preceded by a short 



378 ANTISEPTICS. 

period of excitement — of increased rate of cardiac movement, warmth 
of the surface, flushing of the face, etc. ; then perspiration begins, the 
temperature declines, the pulse slows and becomes weaker, and the 
respirations lessen in number. The degree of antipyretic effect, and 
its duration, vary with the different members of the group. 



Among the newer products recently contributed to pharmacology 
by the chemist's art are salol, antipyrine, thallin, and some others. 
In the eager search for a remedy that may equal if not surpass qui- 
nine, and stimulated by scientific zeal and hope of commercial advan- 
tage, various other agents have been produced, but those treated of 
below possess powers that entitle them to separate and independent 
consideration among the valuable medicaments of the chinoline and 
phenol series of antipyretics. 

Salol. — The name applied to this agent harmonizes with such as 
phenol, naphthol, and others, now in general use. It is a salicylate of 
phenol. As it appears in commerce it is a white powder, having a 
crystalline structure. It is entirely insoluble in water, and hence, 
when first used by Georgi in the form of powder, its antiseptic pow- 
ers remained undetermined. It is made by combining salicylic and 
carbolic acids — sixty of the former and forty of the latter by weight. 
The insolubility of salol in water explains its lack of taste. It is 
asserted that it is equally insoluble in the gastric juice, but dissolves 
freely in the intestinal juices after the pancreatic has joined. If this 
fact be confirmed, we have in our possession an agency that admits of 
nice adaptation in the treatment of morbid conditions of the intestinal 
canal. If carbolic acid remains in the combination until the small 
intestine is reached, no irritant effects occur in the stomach, and at the 
moment it is freed it possesses the maximum antiseptic power (Nenki 
and Sahli). Dose, gr. v — 3 j. 

Properties — Actions and Uses. — Salol can be administered in 
the form of compressed pellet, of powder, pill, or wafer, etc., and as 
it continues intact during its stay in the stomach, can be so timed in 
its administration as to act on the intestinal mucous membrane only, 
or at any stage of the process of intestinal digestion. Salol is the 
most advantageous if not the most powerful germicide. The temper- 
ature of the body has been reduced by it from 104° Fahr. to 98° 
(Nenki, Lepine, etc.). In common with all the antipyretics, the decline 
in the body-heat is coincident with sweats, more or less profuse, but 
not the exhausting sweats accompanied with profound depression of 
the vital powers — the collapse, even — which are caused by many of the 
same group. Furthermore, salol differs from many of the antiseptic 
antipyretics in that the rise of fever after the period of apyrexia is 



SALOL. 379 

not signalized by a chill, a rigor, even a pernicious cold stage. In 
general it may be asserted that salol is free from, any toxic action, al- 
though it may be shown hereafter that there are certain subjects 
affected in a very unfavorable manner by it. Although idiosyncrasy 
is by its nature exceptional, it should not be forgotten that the symp- 
toms present under these circumstances are but exaggerations of nat- 
ural conditions, and are present, probably, in all cases, yet, for the 
most part, are not recognizable because too minute and ill-defined. 

We owe the discovery of the analgesic property of the chinoline de- 
rivatives to Lepine, to See, and several Russian observers (Todorsky). 
Therapeutically, the anodyne property of salol is exhibited in the 
cases that are rheumatic in source. It has also been shown to lower 
the reflex function of the spinal cord, and thus to abate spasm. 

After the decomposition of salol in the intestine — a chemical change 
wrought by the pancreatic juice — its component elements are no 
doubt disposed of in accordance with their individual affinities. 

Under the continued administration of salol, the urine changes in 
appearance just as it does when carbolic acid is the agent undergoing 
elimination. We can not conceive the possibility of Nenki's asser- 
tion being true that the carbolic acid when set free in the intestine 
forms combinations that do not enter the blood. When the quantity 
of carbolic acid absorbed is large, the urine becomes darker, and finally 
almost black in color. The test for carbolic acid and salol is the 
same — i. e., a solution of perchloride of iron, which strikes a fine 
violet color on being added to urine containing them. Hence it is 
proved that carbolic acid has passed from the intestine through the 
kidneys into the urine. The intermediate combinations formed are 
not well known, but it is probable, of course, that when liberated in 
the small intestine it must pursue the course its chemical relations 
require, as we have before stated. 

The dose of salol varies with the circumstances — the maximum, 
when its antipyretic effects are to be produced, being about sixty grains. 
For other purposes from five to ten grains usually suffice. Although 
not manifesting any toxic activity when administered in the doses 
mentioned, it is quite inconceivable that an agent containing so much 
carbolic acid, liberated in the intestine, should not have the powers 
of a poison if given in sufficient amount. We repeat the caution 
already given, and advise our readers to avoid any excess in prescrib- 
ing it for the purposes to which it seems to be so well adapted. 

Therapy. — If the intestinal reaction asserted by Sahli really oc- 
curs, a rational explanation is thus afforded of the curative action of 
salol in catarrhal states of the intestinal mucous membrane. In 
duodenal catarrh, catarrh of the bile-ducts and gall-bladder, in inspis- 
sation of the bile, and in jaundice, it must prove one of our best reme- 
dies, if the observations thus far made are confirmed by future expe- 



380 ANTISEPTICS. 

rience. It is said to liquefy the bile ; hence its remarkable utility in 
that state of the bile known as inspissation, in which deposits form in the 
ducts, thus causing at last occlusion ; but, unlike calculi in this respect, 
the masses of inspissated bile occlude slowly, while the calculi block the 
canal suddenly. By rendering the bile more fluid, salol contributes to 
the solution of inspissated bile and of calculi, provided there be in the 
calculus a break in the continuity of its smooth surface (Levachoff). 

Salol has also the antipyretic property of its congeners, probably in 
a higher degree than any member of the group. It is the more valu- 
able as a remedy for fever, because it has no taste, and does not dis- 
turb the stomach. It has another important advantage : the rise of 
temperature which comes on after the conclusion of the antipyretic 
action is not accompanied by the chilliness, the rigor, and that pro- 
found depression of the vital powers approaching collapse, which seem 
to be necessary to the action of some — of nearly all, in a greater or less 
degree — of the newer antipyretics. 

The first triumphs of salol were won in the treatment of acute 
rheumatism, excelling, as it apparently does, all other remedies in its 
power to abate pain and lessen fever. If all the conditions be pro- 
pitious, by the end of the second or third day fever and joint-pain 
and swelling will have disappeared ; but the rule of practice applica- 
ble to all other remedies is equally applicable to salol — that it is ne- 
cessary to keep up the remedy after the active symptoms have ceased, 
because of the danger of relapses. The duration of the salol treat- 
ment is determined by the success in avoiding relapses for the most 
part. It does not prevent cardiac complications, any more than do 
other remedies. The author has reason to believe, indeed, that a 
larger percentage of the cases now present the evidences of heart mis- 
chief since the use of remedies which so much try the heart by their 
action on the vascular tension. 

It is now quite certain that salol and other remedies of the same 
class have the power to relieve the pains of locomotor ataxia in a re- 
markable degree. This fact is the more interesting because heretofore 
only the ordinary anodynes were available for this purpose. Recent 
experiences have brought to light, also, that the antiseptics — chinoline 
derivatives — have analgesic power of a peculiar kind, in that they 
afford remarkable relief in painful affections due to a pathological 
condition of the peripheral nerves, such as that present in locomotor 
ataxia, neuritis, etc. In this group we may include the cases of genuine 
migraine, and that large and indeterminate class, called rheumatic, of 
which lumbago, sciatica, and myalgia are representatives. The dose 
of salol for these purposes will be from three to ten grains, three or 
four times a day. 

The topical applications of salol are deduced from its physiological 
actions. It is applied in the form of powder, dusted on the surface 



ANTIPYRINE. 381 

or blown on by an insufflator ; in solution dissolved in alcohol, turpen- 
tine, or cotton-seed oil, and mixed with vaseline or other fats. As it 
has no odor, and is more effective than iodoform, its utility is evident. 
It can be mixed with iodoform or iodol, and thus the actions of both 
may be carried on simultaneously. 

Admirable results have been obtained from it in ozcena, otorrhoea, 
gonorrhoea, in chancre, and chancroid ulcers, specific and common. 

If the experiences of the future justify the statements of the pro- 
moters of salol, it will prove a valuable addition to the resources of 
therapeutics, especially in the numerous morbid states where a ger- 
micide only can remove the source and cause of all the mischief. 

Antipyrine. — The chemical name of this remedy is dimethyloxy- 
quinizine, which is so unmanageable that it could hardly be brought 
into general use. The original discoverers and promoters of the new 
agent bethought themselves to name it antipyrine, which is at the 
same time a convenient designation, a trade title to protect the pro- 
prietary rights, and a word significant of the most important property 
possessed by the new remedy. 

Preparations and Physiological Actions. — Antipyrine is a 
whitish or grayish-white crystalline powder, slightly but not persist- 
ently bitter in taste, and is soluble in water in equal parts by weight. 
It has basic properties, and combines with acids to form salts. The 
dose is determined by the uses to which it is applied, and varies from five 
to sixty grains — the maximum employed to reduce fever-heat. When 
massive doses are given, it is better to divide into smaller sections, and 
administer at short intervals, that the impression may be made as a 
unit. Having ready solubility, it may be prescribed in a solution, or 
injected subcutaneously. 

Antipyrine does not irritate the stomach, but is a stomachic tonic, 
and the appetite is increased rather than diminished. On the intestine 
it acts as an antiseptic, inhibits microbes, and thus prevents fermenta- 
tive changes. It is probable that it increases secretion, and stimulates 
the intestinal peristalsis also. 

Antipyrine diffuses into the blood promptly, and, when the quantity 
is sufficient, brings about important changes in its constitution ; the 
corpuscles are altered in form, the hgematin separated, and the whole 
mass of the blood assumes in consequence a chocolate tint. On the 
organs of circulation the first effect is excitant in character, but it is 
brief in duration ; the heart-beat is quicker ; there is a flush, and a 
subjective sensation of warmth. Then perspiration begins, and may 
be very profuse ; the pulse lessens in frequency ; a sense of chilliness 
or a chill accompanies the pallor of the surface, and the temperature 
declines from one to five degrees according to the nature of the seiz- 
ure and the doses given. In some instances the decline in body-heat 



382 ANTISEPTICS. 

passes below normal, but this result is observed more frequently when 
some other of this antipyretic group is used. The decline of the 
febrile heat begins in ten to twenty minutes after the dose has been 
given, and it persists from an hour to sixteen hours or longer accord- 
ing to circumstances. The normal temperature of the body is not 
affected, how large soever are the doses administered. 

Antipyrine appears to be free from one source of danger common 
to the germicide antipyretics — the profound depression, almost collapse, 
which comes on with the sweating and precedes the next exacerba- 
tion of the fever, and in fact ushers it in. Although antipyriue is free 
from this dangerous depression, as a rule, there occur in certain sub- 
jects, with the sweating, some cardiac weakness and irregularity, of 
anunpleasant character, and hence it can not be asserted that this 
member of the group is free from the dangers inseparable from the 
action of the others, but it is far less toxic. 

Antipyrine rather lessens the reflexes, and it possesses some anal- 
gesic property corresponding to that of the class. 

It is eliminated chiefly by the kidneys, and induces the changes in 
the urine characteristic of the group to which it belongs. 

Theeapt. — Having been discovered by Knorr, the power to 
lessen febrile heat was first investigated by Filehne, Schmidt, Nau- 
nyn, Gerhardt, and others. It was soon ascertained that antipyrine is 
an effective remedy for fever, the best, up to the present time, for the 
relief of that symptom, but not possessed of any power to alter the 
morbid condition producing the feverish state. As Huchard has hap- 
pily expressed it, " Antipyrine is an antipyretic, but not an anti-pe- 
riodic." It has been proved to have special power to reduce the high 
temperature of tuberculosis. It does not act with equal advantage in 
all cases, and inattention to the proper mode of administration will 
impair its usefulness. The experience thus far gained has shown 
that a few full doses will have a more happy effect than numerous 
small doses ; but in either case, the periods of apyrexia, especially the 
sweating stage, are not suitable, and if administered at these times 
there is danger of upsetting the stomach and increasing the cold 
sweat. Fifteen grains after the onset of the fever, and repeated two 
or three times in as many hours, according to necessity, is the best 
mode of giving it. 

Although antipyrine is the most efficient antipyretic in cases of 
tuberculosis, it does not change existing morbid states. The reduction 
of temperature effected by it lasts six to twenty-four hours, accord- 
ing to the quantity given, the susceptibility of the patients, and other 
circumstances, and when the elevated temperature comes on again it 
may continue for several days below the general level of the fever 
previously (Huchard). 

The published experience in the great journals of professional opin- 



ANTIPYRINE. 383 

ion, in respect to the utility of antipyrine in typhoid, now constitutes 
a vast literature of itself, and we can utilize here only the epoch-making 
papers. That antipyrine is a safe and efficient antipyretic in typhoid 
is generally admitted, but no one takes the position that it has a cura- 
tive effect, or that the reduction of temperature has any influence of a 
permanent character on the dangers or duration of the fever. In the 
condition of hyperpyrexia its timely administration has proved very 
beneficial. 

In the symptomatic fevers, such as pneumonia, the action of anti- 
pyrine has not been favorable, although reduction of temperature is a 
very constant result of its administration. In no form of febrile dis- 
ease has it been so efficient as in acute rheumatism, and here it main- 
tains the first place as a remedy in this disease, unless the advent of 
salol shall consign it to the second place. In acute rheumatism it is su- 
perior to the salicylates, and to other remedies, unless salol prove more 
efficient. From fifteen to twenty grains, every three to six hours, will 
be required until the cessation of joint-pain, and the disappearance of 
the swelling. Under the action of antipyrine, as has been the result 
from all other remedies, a tendency to relapse is observed in a propor- 
tion of the cases, and hence persistence is necessary in the use of the 
remedy for some days after the attack has apparently ceased, but 
the amount given should be slowly reduced. 

Antipyrine has the same power to reduce temperature in the mala- 
rial as in other fevers, but no power to prevent paroxysms — no anti- 
periodic quality. Hence it can never be used successfully in intermit- 
tent and remittent fevers, although several prominent therapeutists 
affirm the contrary (Potter). 

The antipyretic quality which, at the outset, was supposed to be 
the one attribute of the chinoline derivatives, has proved to be less 
valuable than the analgesic property, which they all possess to a vary- 
ing extent. When Filehne demonstrated the antipyretic actions, he 
did not pursue the investigations into the effects of antipyrine on the 
nervous system, and the clinical studies which followed immediately 
throughout Germany (Guttmann, Bielochowsky, Pibram, and others) 
were occupied with its influence over the temperature in the course of 
the more important fevers. 

The remarkable relief afforded by antipyrine and other members 
of the group in acute rheumatism led to their use in cases of neuritis, 
sciatica, and some other painful diseases. We are indebted to Professors 
Lepine and Huchard more especially for demonstrating the influence 
exerted by these agents over certain painful affections. It seems quite 
clear that the relief given is in maladies due to central and peripheric 
lesions of the nerve apparatus — for example, the pains of locomotor 
ataxia, neuralgia of the fifth nerve associated with neuritis, and sci- 
atica due to the same cause. 



384 ANTISEPTICS. 

Affections of a painful character. are amenable to the action of an- 
tipyrine in proportion to the rheumatic influence or diathesis dominat- 
ing them. By subcutaneous injection, it has proved to be very effect- 
ive in many painful affections that have their seat in the nerves. 

The members of this group of remedies have the power to dimin- 
ish the reflex function, and hence have been used in the various spas- 
modic affections, as epilepsy, chorea, etc., with a measure of success, 
but not in so great a degree as to become substitutes for other tried 
remedies. 

Exanthem. — Various eruptions have accompanied the action of all 
the members of this group. They have varied in severity, from a sim- 
ple erythema to the more formidable bullae, ^pemphigus, etc. Ec- 
zema, erythema nodosum, acne, impetigo, etc., are the usual forms. As 
a rule, they subside spontaneously when the remedy is discontinued. 

Naphthalin. — According to Fronmuller, naphthalin (or naphtalbi) 
was discovered so long ago as 1820, but its applications in medical prac- 
tice have been developed since the subject of antiseptics and bacteri- 
ology have assumed so important a place in modern pathology and 
therapeutics. It is now obtained in quantity from a by-product of gas- 
manufacture, and after purification appears in commerce in the form 
of rather brilliant, rhombic crystals, having a somewhat aromatic but 
acrid, burning taste. It is not soluble in water, but dissolves in ether 
and acetic acid. 

The best form for the administration of naphthalin internally is 
the compressed pellet, and this form secures the preservation of the 
drug as well as facilitates the administration. Naphthalin may be 
combined with any aromatic powder — for example, the official pulvis 
aromaticus compositus, powdered nutmeg, or cinnamon — and given as 
a powder. The dose ranges from one quarter of a grain to five grains. 

Naphthalin does not distress the stomach nor cause nausea, the 
present experience being that it is rather a stomachic tonic. It is sup- 
posed that it passes unchanged from the stomach into the intestine, 
where it acts as an antiseptic. The proof of this action is afforded by 
the complete deodorization of the stools. To remove the fecal odor 
from a mass of faeces implies the possession of great powers, and is 
conclusive as to changes occurring in the naphthalin itself. It follows 
that the fermentative processes producing more or less of the offensive 
compounds of sulphur, phosphorus, and carbon, must be arrested by 
naphthalin. 

Although insoluble in water, this remedy diffuses through the body, 
and ultimately escapes in part from the lungs and kidneys, but largely 
in the faeces. It has some mysterious influence on the function of 
nutrition, or on fhe trophic nervous system, for, when given to dogs 



NAPHTHOL. 385 

freely, cataracts form. No such result can be expected from its me- 
dicinal use in man ; but a judicious practitioner will hardly risk such a 
result by large doses, protracted administration, and careless obser- 
vation. 

The therapeutical applications are based on the studies that have 
been made of its physiological actions ; they are both internal and 
external. Dupasquier advises the following solution for the stomachal 
administration : Naphthalan, 3 j ; dissolve in boiling alcohol and add 
sufficient simple sirup to make up to eight ounces. A tablespoonful 
can be taken three or four times a day. This formula is said to be an 
excellent expectorant, and to remove the fetid character of the pus in 
some cases of bronchorrhoea. The most important of the internal 
uses of naphthalin is in the treatment of diarrhoea, dysentery, round 
worms, and typhoid. Rossbach has found it very useful in the first 
two, and the author has had excellent results in some cases of chronic 
dysentery. Also, it has appeared to the author to be of great relative 
utility in the cases of diarrhoea due to obstruction of the portal circu- 
lation. In chronic dysentery and diarrhoea, acute and chronic, it has 
proved very successful in the practice of Dolgopoloff. 

Naphthalin has an effect on the genito-urinary tract, in passing 
through in the urine, which is of no little service in catarrhal states of 
the mucous membrane, in pyelitis, cystitis, etc. Offensive urine is 
sweetened by it, and hence an impression is made on the catarrhal pro- 
cess. On the other hand, Prof. Rossbach asserts that in certain sub- 
jects its administration for other purposes may excite a violent cys- 
titis with strangury, and that it must be administered with caution 
when the kidneys are damaged. 

The external uses of naphthalin consist in applications to ulcers 
(syphilitic, varicose of the leg, or other unhealthy and sloughing forms), 
in leucorrhcea of a fetid character, in gonorrhoea and cognate affec- 
tions. Fronmtiller asserts that he has had "marvelous results" in 
some cases of bed-sores caused by prolonged decubitus. The same 
authority affirms its superiority to iodoform in these diseases. 

In eczema, pityriasis, psoriasis, etc., it is often highly beneficial. 
An ointment with vaseline (1 to 3) is recommended when there is in- 
telligent supervision. 

Naphthol. — There are two naphthols, derivatives of naphthalin, but 
£eta-naphthol is the one prescribed. It has increased considerably in 
use in the past year, having similar properties to tar, and hence em- 
ployed as a substitute in the treatment of skin affections. It is used 
in the form of ointment with vaseline dissolved in alcohol, ether, or in 
olive-oil, in the proportion of two to ten per cent. Although not solu- 
ble in water, it is readily diffusible, and may bring on toxic symptoms 
if too lavishly applied to a fresh surface. The character of its toxic 
26 



386 ANTISEPTICS. 

effects is similar to those of the other members of the group, and need 
not be described here. 

Pyridine. — The last of the chinoline series to be considered here 
is pyridine, a volatile liquid, having a strong, diffusive, and some- 
what aromatic odor. Its vapor is given off at ordinary temperatures, 
and its therapeutical effects are obtained by inhalation. We owe the 
valuable suggestion of its inhalation for certain purposes to Prof. 
See, who ascertained that it acts on the reflex function of the cord, 
and also on respiration. The special purpose for which it is pre- 
scribed is the treatment of asthma, and this condition is relieved, 
what cause soever may have developed it. The manner of its em- 
ployment is simple : it consists in placing a saucer containing some 
pyridine ( 3 j, for example) in a large closet or small room that can 
be tightly closed, the patient remaining in it for twenty to thirty 
minutes, and repeating the same procedure two, three, or five times 
a day as may be necessary. In simple asthma a cure may be effect- 
ed in ten to thirty days, and in symptomatic asthma, emphysema, 
etc., remarkable relief is obtained. Prof. See does not advise pyri- 
dine as the sole remedy, for the iodides constitute the true curative 
means, in his belief. 

With the inhalation of pyridine vapor can be combined ethyl iodide, 
the latter contributing the iodine which is so effective of itself in many 
cases of asthma. 

Pyridine has basic properties, and forms crystallizable salts with 
acids, which, however, are somewhat unstable. It mixes with svater in 
all proportions, but, as it is exceedingly volatile, should be prepared 
as required. The dose for internal use is from five to twenty minims. 
Exhibited in this way, it increases the power of the cardiac contrac- 
tions, raises the tension, and greatly lessens respiratory embarrassment. 
Its action resembles that of digitalis, for which it may often be sub- 
stituted with distinct advantage (De Renzi). The salts can be used 
in lieu of the volatile pyridine in many cases. 

Phenacetin. — Among the more recent contributions to the anti- 
septic and antipyretic group, phenacetin is the most promising. 
Although without danger in the dosage necessary for therapeutic 
purposes, some persons suffer from the sweating, chilliness, and 
weakness, which occur in a greater degree when the other mem- 
bers of the group are used. The dose of phenacetin ranges from ten 
grains to thirty, in twenty-four hours, and three grains every two, 
three, or four hours will have sufficient effect on febrile heat for the 
most part. It is little soluble in water, and is best given in wafer, 
capsule, or powder. 

Comparing phenacetin with other well-known remedies of the same 



SACCHARIN. 387 

class, it is found that a dose of ten grains is equal to one of fifteen 
grains of antipyrin, of quinine, and of kairin — to thirty grains of 
salicylate of soda and thirty grains of thallin. Dose for dose as com- 
pared with antifebrin (acetanilid), it is as effective in reducing heat, 
but the action less prompt, and yet it endures longer. 

The action that confers on phenacetin its antipyretic power is the 
change in the composition of the red blood-globules, whereby the 
oxidizing effect carried on by these bodies is lessened or arrested en- 
tirely. It is poisonous to animals, but not to man [Malmert, Dujardin- 
Beaumetz, and others]. 

Phenacetin is a remedy in rheumatismal affections of the first 
order. In fevers, as an antipyretic and as an analcasic in painful 
affection, it is as useful certainly, if not more so, than any other of 
these remedies. 

Saccharin, as it has been happily named, is, in chemical language, 
orthosulphaminbenzoic acid. It is an apparent paradox that an acid 
should be at the same time the sweetest substance in nature, which 
saccharin is. Having no influence on the system, it is not a remedy, 
but is mentioned here for special reasons. It can be made use of by 
diabetics as a substitute for sugar ; and as an acid can combine with 
alkaloids — for example with quinine, which would form the sulpha- 
minbenzoate of quinine, in which the bitter taste of the base is almost 
entirely extinguished. 

Besides its utility as a sweetening agent, saccharin has proved 
successful in some morbid states of the intestinal mucous mem- 
brane. In chronic intestinal catarrh, duodenal catarrh, and catarrh 
of the bile-ducts, the author has seen excellent results. It has ap- 
peared to be especially useful in those affections as they occur in 
children. 

In combination with an alkaline base, as may be readily effected 
in the small intestine, saccharic acid has antipyretic and antiseptic 
powers like those now possessed by other new remedies. Its chief 
use in the treatment of diseases will no doubt be in the direction 
already indicated ; but if it proves to be so powerful an antiseptic as 
it has in catarrh of the bladder, its uses are merely at the begin- 
ning. 

Acidum Boricum. — Boracic acid. Acide boracique, Fr. ; Borsaure, 
Ger. 

Peopekties. — Boracic acid occurs in glittering, white, scaly crys- 
tals. It is soluble in twenty-six parts of cold and in three parts of 
warm water, and is freely soluble in alcohol. 

Actions and Uses. — Boracic acid possesses decided antiseptic and 
deodorant properties. It arrests fermentations and putrefactive de- 



388 ANTISEPTICS. 

composition, and is destructive of minute organisms — bacteria, vibrio, 
etc. Applied to wounds, it is free from irritating effects ; it lessens 
suppuration, and prevents decomposition. 

Boracic acid occupied an important place in Lister's antiseptic 
method. It appears to be as effective as carbolic acid, and is even less 
irritating to the tissues than salicylic acid. A saturated solution may- 
be employed as a dressing to fresh wounds to prevent the action of 
atmospheric germs, or to arrest decomposition in gangrenous, slough- 
ing, or ill-conditioned wounds. " Boracic lint " is made by steeping 
lint in a saturated solution of boracic acid at the boiling-point ; and, 
after drying, it is found to hold a large quantity of the acid, weighing 
nearly twice as much as before being thus treated. 

Mr. Lister's directions for the application of boracic-acid dressings 
to ulcers are as follows : " The first step is to cleanse the sore and the 
surrounding skin once for all from septic impurity. This is done by 
treating the surface of the sore freely with a solution of the chloride 
of zinc (forty grains to the ounce) ; and at the same time washing the 
integument with a strong watery solution of carbolic acid, which is 
used on account of its remarkable power of penetrating the epidermis, 
while for the sore itself the solution of the chloride appears to be more 
efficient. This preliminary step having been taken, the boracic dress- 
ing is at once employed as follows : A piece of oiled-silk protective, 
of sufficient size to cover the sore and slightly overlap the surrounding 
skin, is dipped in the boracic lotion (a saturated, watery solution) and 
applied, and over this a piece of boracic lint large enough to extend 
for an inch or more beyond the protective on all sides, the whole be- 
ing retained in position with a bandage." 

Mr. Lister has used boracic solutions with great success in pruritus 
ani } ulcers, skin-grafting, bums and scalds, eczema, in operations on the 
penis, etc. By Mr. Watson, these solutions have been employed with 
excellent results in the dermatophyta ; for example, tinea tonsurans 
and t. circinata — especially " in that very troublesome form of the dis- 
ease which affects the scrotum and inner side of the thigh." 

Boracic ointment may be made as follows : " Take of boracic acid 
finely levigated, one part ; white wax, one part ; paraffin, two parts ; 
almond-oil, two parts. Melt the wax and paraffin by heating them 
with the oil, and stir the mixture briskly along with the boracic-acid 
powder in a warm mortar until the mixture thickens." When required 
for use, this ointment should be rubbed up with a little glycerin to 
the proper consistence, and then spread on muslin or linen. 

Boracic acid may be employed in all the various forms and combi- 
nations in which carbolic and salicylic acids are now used by the anti- 
septic method. 

Borocitrate of magnesia, originally proposed by Becker, has been 
recently strongly urged by Madsen as a solvent of urinary calculi of 



BENZOIN. 389 

the uric-acid variety. It may be extemporaneously prepared as fol- 
lows : £> Magnesii carbonat., 3 j ; acid, citric, 3 ij ; sodii biborat., 
3 ij ; aquae bul., 5 viij. M. Sig. : A tablespoon!" ul three or four times 
a day. 

Tartraborate of potassium is, probably, a more generally useful 
remedy for the purpose above indicated, as the potash compounds of 
uric acid are more soluble than the soda compounds. As a solvent of 
uric-acid calculi, this salt is preferable. It is obtained by heating to- 
gether four parts of cream of tartar, one part of boracic acid, and ten 
parts of water. It is a white powder, or occurs in transparent scales, 
has an acidulous taste, and dissolves in two parts of cold water. A 
scruple may be given three or four times a day in water, and the more 
largely diluted it is, the better when used for the solution of calculi. 

Authorities referred to : 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, erster Band, 
p. 284. 

Lister, Prof. Joseph. On Recent Improvements in the Details of Antiseptic Surgery. 
The Lancet, vol. i, 1875. 

Watson, Mr. Indian Medical Gazette. The Lancet, vol. ii, 1875, p. 750. 

Benzoinum. — Benzoin. A solid balsam obtained from Styrax ben- 
zoin. Benjoin, Fr. ; Benzoeharz, Ger. 

Composition. — Benzoin is made up of resins. When subjected to 
dry distillation it yields benzoic acid, which is contained in it in the 
proportion of fourteen to eighteen per cent. Certain varieties of ben- 
zoin contain, also, cinnamic acid. 

Tinctura Benzoini. — Tincture of benzoin, twenty parts ; alcohol, 
sufficient to make one hundred parts. Dose, 3 ss — 3 j. 

Adeps Benzoinatus. — Benzoin ated lard. Benzoin, two parts ; lard, 
one hundred parts. 

Tinctura Benzoini Composita. — Compound tincture of benzoin. 
(Benzoin, socotrine aloes, storax, balsam of tolu, alcohol.) Dose, 3 ss 
— 3 ij. 

Acidum Benzoicum. — Benzoic acid. Is in white, feathery crystals, 
of a peculiar, agreeable odor, and warm, acidulous taste, sparingly sol- 
uble in cold water, more soluble in boiling water, which deposits it in 
part on cooling, and very soluble in alcohol. Dose, gr. v — 3 ss. 

Amrnonii Benzoas. — Benzoate of ammonia. Is in minute, white, 
shining, thin, four-sided, laminar crystals, with a slight odor of official 
benzoic acid, and a bitterish, saline, somewhat balsamic taste, and 
slightly acrid but persistent after-taste. It is soluble in five parts of 
water and in twenty-eight parts of alcohol. Dose, grs. v — 3 ss. 

Sodii Benzoas. — Benzoate of sodium. A white, semi-crystalline 
or amorphous powder, efflorescent on exposure to air, odorless, or hav- 
ing a faiat odor of benzoin, of a sweetly astringent taste, and neutral 



390 ANTISEPTICS. 

reaction. Soluble in 1 *8 parts of water, and in forty-five parts of alco- 
hol at 60 Fahr. Dose, gr. v — 3 j. 

Actioxs axd Uses. — The physiological effects of benzoin and its 
preparations are due to benzoic acid. Taken in very considerable 
doses ( 3 ss), benzoic acid produces some epigastric heat, increases the 
pulse-rate, and promotes bronchial and cutaneous transpiration. The 
acidity of the urine is rendered more decided by it. A large part of 
the acid is excreted by the kidneys as benzoic acid, and a part under- 
goes conversion into hippuric acid. 

Recent observations have shown that benzoic acid has decided an- 
tiseptic properties (Salkowsky). It manifests the same power to pre- 
vent fermentations and putrefaction, and to destroy minute organisms, 
as that possessed by salicylic and boracic acids. 

The tinctures of benzoin were formerly used as expectorants in 
chronic bronchial affections. They are now sometimes resorted to for 
the local treatment (by atomization) of chronic laryngeal affections. 
Their most important use, however, is in the treatment of foul- smelling 
wounds, flabby granulations, etc. Unhealthy or sloughing wounds 
may be dressed with linen or cotton cloths saturated with the tinctures, 
with the effect to destroy fetor and stimulate to a more healthy growth. 
Chapped hands and lips and fissured nipples are best treated, accord- 
ing to Stille, with a mixture of compound tincture of benzoin and 
glycerin. Benzoic acid may be used as a substitute for boracic and 
salicylic acids in the antiseptic treatment of wounds. Its solubility in 
water can be increased by the addition of borax. 

Benzoate of ammonia is a remedy of great utility when the urine is 
ammoniacal and loaded with phosphates. Under its use the urine be- 
comes acid, and the fermentative changes are arrested. In chronic 
cystitis, arising from any cause, this remedy should be prescribed when 
the urine undergoes the alkaline fermentation. Incontinence of urine, 
when due to an alkaline reaction of this excretion, is cured by the ben- 
zoate of ammonia. Phosphatic calcidi may be dissolved by the long- 
continued use of this remedy. 

Benzoate of sodium has lately occupied a large place in profes- 
sional attention. Having similar antiseptic and antipyretic properties 
to those of salicylate of sodium, and being without any in jurious effect, 
it came to be largely used in the septic maladies. The first important 
observations were those of Dr. Klebs, of Prague, who announced that 
this salt can be used with good effects in all infectious febrile diseases ; 
that while the febrile movement does not cease as quickly as after the 
use of sulphate of quinine and salicylate of sodium, the results obtained 
from the benzoate are more permanent. Moreover, absolutely no un- 
pleasant after-effects were observed from this remedy, even when its 
use was much prolonged, and as much as three hundred and eighty 
grains daily could be taken without inconvenience. The usual daily 



BENZOIN. 391 

quantity required in the treatment of diseases is ten to fifteen grammes, 
or one hundred and fifty to one hundred and eighty grains. Dr. Klebs 
advised the use of benzoate of soda in the acute infectious diseases, in 
tuberculosis, and catarrh of the bronchi. The principle underlying 
these suggestions of Dr. Klebs is the antiseptic. He holds that the 
maladies in question are of parasitic origin. The appropriate remedy 
is an antiseptic, destructive of germs. There are several remedies 
having these powers, but benzoate of sodium is best, because, while 
very destructive of minute organisms, it is free from injurious effects 
on the body. A remarkable and sudden extension was given to the 
use of this salt by the report from Innspruck, that cases of consump- 
tion far advanced were being quickly cured in the clinic of Prof. 
Propop Rokitansky. Subsequent investigations proved the inaccu- 
racy of such observations. Klebs held that he had proved the para- 
sitic origin of phthisis, and Prof. Schiiller, of Greifswald, confirmed 
his statements by additional experiments. It was discovered in 
Klebs's laboratory that, if animals were made to inhale the spray of 
benzoate of sodium, tubercular and diphtheritic matter did not affect 
them. Then followed the treatment of cases of consumption, by spray 
of a solution of the benzoate. Although the first claims put forth 
were greatly exaggerated — not entirely unfounded — there is reason to 
believe that the free use of benzoate spray is of service in some cases 
of consumption. According to the estimate of Rokitansky (Propop), 
the patient must inhale y-^- -g- of the body-weight daily of the ben- 
zoate in the form of spray, to do any good. Among the numerous 
observations in opposition to the views of Klebs and bis followers, may 
be selected those of Guttmann, who found that the treatment did not 
relieve a single symptom, and that there was no appearance in the 
affected lungs of any attempt at reparation. 

Benzoate of sodium has been used in other infectious diseases. 
Thus Letzerich has employed it with success in the teatment of diph- 
theria. Of twenty-seven cases treated with this remedy in one epi- 
demic, only one proved fatal, and this was an infant of feeble consti- 
tution. He gave from five to twenty grammes daily (seventy-five to 
three hundred grains), according to age, and applied the powdered 
benzoate by insufflation to the diseased parts. Other physicians have 
not been so largely successful, but many very favorable reports have 
been published (Kien, Hoffmann). Thus Demme found it highly ser- 
viceable in diphtheria and scarlet fever. It is well established that 
benzoate of sodium, added to the diphtheritic fungus, renders it harm- 
less, so that the local use is founded on sound reasons. As an anti- 
pyretic in the eruptive fevers, in typhoid, and in malarial fevers, this 
salt may be preferred to the salicylate, than which it is safer, although 
much less effective as an antipyretic. In acute rheumatism it has been 
administered by Senator, McEwan, and others, who have found it a 



392 ANTISEPTICS. 

good and safe remedy, but not so active as salicylic acid. Tordens has 
treated whooping-cough successfully, using the prescription of Letze- 
rich : P£ Sodii benzoat., 3iv; aquas destil., aquas menth. pip., aa 3 x ; 
syrup, aurantii, 3 ij. M. Sig. : Two drachms every hour or two. 

Authorities referred to : 

Demme, Dr. Allg. Wiener med. Zeitung,~No. 24, 1880. 

Guttmann, Dr. Paul. Berliner klin. Wochen., December 8, 1879. 

Klebs, Dr. Allg. med. Centralzeitung, June 5, 1878. 

Kohler end Dittel. Berliner klinische Wochen., No. 44, 1879. 

Letzerich, Dr. Berliner klinische Wochen., No. 1, 1879. 

McEwan, Dr. David. British Medical Journal, March, 1881, p. 336. 

Salkotvskt, Dr. E. Virchoufs Archiv, B. lxxviii, p. 30. 

Senator, Dr. Zeitschrifi fur klinische Med., Baud i, p. 41. 

Tordens, Dr. Edouard. Jour, de Med. de Bruz., May, 1880. London Medical Record, 
August 15, 1880. 

Acetanilide (Antifebrin). — Although long known to chemists, ace- 
tanilide has only recently been subjected to adequate physiological and 
clinical investigation. The term antifebrin, by which it is best known, 
is a proprietary designation ; acetanilide is a more scientific term, un- 
restricted in use, and hence should be preferred. Also, the name anti- 
febrin expresses but one, and not the most important, of its powers. 

Properties — Physical and Physiological. — Acetanilide is a 
white, crystallized powder, without odor, and having a slight, charac- 
teristic, but not disagreeable taste. It is soluble to some small extent 
in cold water, 1 part to 160 ; more soluble in warm water, 1 part to 
50 of water at 105° Fahr. ; and dissolving readily in alcohol (3*5), in 
ether (6), and in chloroform (7). Chemically, acetanilide is aniline, 
less an atom of hydrogen replaced by acetyle. The dose ranges be- 
tween four and eight grains. The latter quantity need rarely be ex- 
ceeded in a single dose, but a considerably larger amount can be safely 
administered in twenty-four hours. Drachm-doses have been taken 
by healthy persons without suffering. There are important differences 
in the action of moderate medicinal and of toxic doses (Weill), for the 
effect of the latter on the blood-globules introduces a special pathogenic 
influence which must change the character of the symptoms produced. 

Ordinary medicinal doses do not irritate the stomach, and indeed, 
as the author has observed, sometimes allay nausea. Notwithstand- 
ing its insolubility, acetanilide rapidly diffuses into the blood. The 
normal constituents of the blood are quickly changed in composition ; 
the oxyhemoglobin lessens in quantity, and a corresponding formation 
of methyhaBmoglobin takes place. The effect of such changes is to 
seriously modify that function entitled the " ozonizing function," and 
to impair constructive-tissue metamorphosis, and with it heat-produc- 
tion. The effect of full medicinal doses in this way is partly mani- 
fested in the cyanosis usually present, but, as no ill result occurs, it 
is certain that the change is only temporary. The reduction of tem- 
perature takes place only when fever is present, and no action follows 



ACETANILIDE. 393 

the administration of the remedy during apyrexia. It results from this 
fact that, to obtain the fullest effect from acetanilide as an antipyretic, 
it should be given at the point of maximum elevation of temperature. 

Acetanilide raises the intra-vascular blood-pressure, chiefly by con- 
tracting the peripheral arterioles, and thus increases the work of the 
heart. As the vascular tension rises, the heart-beats lessen in number, 
but gain in force. After a time, as is the physiological law, the stimu- 
lation of the cardiac motor apparatus is succeeded by diminished ac- 
tion and irregularity of the rhythm — consequences of a protracted and 
powerful impression on the centers of reflex action, and of the vaso- 
motor system. It is a curious fact that, in a considerable number of 
persons, only the effects on the nervous system are produced, and a 
decline of temperature and failure of respiration are not experienced. 
The mind continues clear, and vocal expression is not impaired, until 
the serious changes wrought in the blood bring about coma and insen- 
sibility. As the effects of the medicament are developed, the reflexes 
lessen, and the irritability of motor and sensory nerves and of the 
pneumogastric progressively declines. Analgesia and anaesthesia are 
products of its action, but it is evident that the interference in the 
respiratory function of the blood has much to do with the functional 
changes occurring in the nervous system. 

In the beginning, acetanilide excites increased action in the central 
nervous apparatus, but, as the impression gains in force, a quantitative 
decline takes place in the functions of motility and sensibility, and 
ultimately they are suspended entirely. Large doses have so serious 
an effect on the red blood-globules that collapse follows a brief period 
of excitement. As the antipyretic power is due to the injury done to 
the "ozonizing function of the blood," as has been explained, it is 
clear that the therapeutical applications for diminishing fever-heat are 
not without danger, and, although it is an efficient remedy for this 
purpose, it is probably not safer when the proper dose is exceeded than 
the other antipyretics of the same character. It is true, to accomplish 
a given result, so small, comparatively, is the dose required, that it is 
not necessary to exhibit that quantity which will produce dangerous 
symptoms. In common with the antipyretics of this class, but far less 
frequently and severely, acetanilide causes sweating at the end of its 
impression, and a rigor as the temperature begins to rise again. 

Opinions differ somewhat in regard to the certainty and the power 
of acetanilide as an antipyretic. Eisenhart, Riese, Krieger, and other 
German observers, find it to be extremely uniform in its effects on 
febrile heat ; but Dujardin-Beaumetz holds that small doses will some- 
times have a decided power to lessen the temperature ; and, again, 
quite large doses will fail of effect. He regards it, therefore, as a rather 
capricious antipyretic, and hence inferior to antipyrine for this purpose, 
although threatening symptoms are but rarely induced by its thera- 
peutical administration, with the exception of cyanosis, which occurs 



394 ANTISEPTICS. 

when the larger doses are given, but does not necessarily indicate an 
untoward action. 

The amount required to produce distinct antipyretic effects ranges 
from four to eight grains, the latter dose having proved to be an effect- 
ive quantity for lessening fever-heat in general. A much larger quan- 
tity can be given with entire safety, if the circumstances demand the in- 
crease. Huber has administered from sixty to seventy grains, and from 
ninety to a hundred grains in twenty-four hours, without any ill effects. 
The reduction of temperature begins in one to two hours after the dose 
has been taken, and the effect is maintained for four to twelve hours. 

Therapy. — The applications of acetanilide to the treatment of dis- 
eases are based on its physiological actions. There are two directions 
in especial that its curative powers take : to lessen fever (antipyretic 
action) ; to diminish the functional activity of motor and sensory 
nerves, and to inhibit reflex actions. 

As respects fever, when the high temperature must be reduced, 
acetanilide is effective, and although it may exert less power than an- 
tipyrin, has many advantages, in size of dose, ease of administration, 
and freedom from untoward effects. Its special field of utility is the 
relief of inflammatory conditions of nerves. In neuritis, the author 
has found it so effective that it has seemed to have specific action. 
The pains (neuralgia, myalgia, etc.) due to inflammation of nerves 
are, as a rule, soon relieved, and the dose for this purpose need not 
exceed three to five grains ter die. In optic neuritis, with pain, Du- 
jardin-Beaumetz finds it exceedingly effective, not only in removing 
the nerve-pain, but in arresting the inflammatory process on which 
the pain depends. Very admirable results have been had from acetan- 
ilide in the pains of locomotor ataxia. As all the world knows, these 
pains have not hitherto been at all readily relieved by the means avail- 
able, and hence the importance of this recent contribution to our re- 
sources. The pains of herpes zoster, and of sciatica produced by local 
injury, have also been promptly arrested by this remedy, while no ap- 
prehension of a habit has intervened to lessen the satisfaction derived 
from its curative power. 

To Lepine, of Lyons, to whom we owe the first knowledge of the 
curative power of acetanilide in the affections of the nervous system 
mentioned above, and to Dujardin-Beaumetz, we are also indebted for 
the suggestion of its use in epilepsy. The experiences and observations 
thus far accumulated do not warrant the statement of exact formula 
to guide the administration. That it lessens reflex excitability and 
opposes spasm is evident, but such an action does not include the whole 
of its powers. The impression made by acetanilide on the vaso-motor 
system must be taken into account as an element in its curative action. 
As it causes contraction of the arterioles, and slows somewhat the 
heart-beat, it must be more useful in those cases of epilepsy character- 
ized by full habit, active circulation, redness of face, injection of the 



ANTISEPTIC OILS. 395 

conjunctivas, etc., than in the anaemic, the pale and feeble. For similar 
considerations, it will prove more useful in diurnal than in nocturnal 
epilepsy, for, as in the state of sleep there is an anaemic condition of 
the brain, it is probable that an agent contributing to this will only- 
increase the tendency to convulsions. 

Exalgine. — By this name a new remedy having valuable anodyne 
property has been introduced by Dujardin-Beaumetz and Bardet. It 
is a derivative of acetanilid with methyl, and hence the name, given to 
designate, not its composition, but its most important curative power. 
The chemical name is Orthomethylacetanilid, which is too difficult 
and unwieldy for general use. It has proved to be a highly effective 
remedy for neuralgia, and is free from ill effects. The dose required 
for internal exhibition in painful affections is determined by the de- 
gree of pain and the nature of the cause producing it. As a hypnotic 
it has proved to be one of the most effective, and this without any of 
the immediate and remote actions of a disagreeable kind. 

Antiseptic Oils. — Oleum, Caryophylli. Oils of cloves. 

Composition. — Oil of cloves consists of two substances — a hydro- 
carbon, light oil of cloves, and an oxygenated oil, eugenol, which has 
acid properties, and is therefore called eugenic acid. The light oil of 
cloves is isomeric with the oils of turpentine, copaiba, and cubebs. 

Salicylic acid and a camphor known as caryophyllin are also con- 
stituents of the oil of cloves. Dose, gtt. ij — gtt. v. 

Oleum Gaultherice. — Oil of gaultheria. 

Spiritus Gaidtherice. — (Oil of gaultheria, 3 parts ; alcohol, 97 parts.) 
Dose, 3 ss — 3 ij. 

Composition. — Oil of gaultheria contains a hydrocarbon, gaulthe- 
rilen, and an acid, methy salicylic acid, to which the acid reaction of 
the oil is due. Dose, gtt. v — gtt. xx. 

Oil of gaultheria has been proposed and used successfully as a 
substitute for salicylic acid in the treatment of rheumatism, gout, and 
affections dependent on these diatheses respectively. It is best given 
in the form of an emulsion, and it may be combined with other agents 
having corresponding powers : thus — IJ Olei gaultheriae, 3 j ; acidi 
salicylici, 3iv ; sodii biborat., 3j; syrup, picis. liquid., | ij ; aquae 
anisi, f ij. M. Sig. : Two teaspoonfuls every four hours. 

Oleum Thymi. — Oil of thyme. The volatile oil obtained from 
Thymus vulgaris. 

Composition. — Oil of thyme contains a hydrocarbon which, by 
fractional distillation, is resolvable into cymene and thymene. Its 
most important constituent is a solid crystalline substance, having 
acid properties and homologous with carbolic acid. This is known as 
thymol, or thymic acid. Dose, gr. ij — gr. x. 

Oleum Cajuputi. — Oil of cajeput. The volatile oil obtained from 
the leaves of Melaleuca cajuputi. Dose, gr. v — gr. xx. 



396 ANTISEPTICS. 

Composition. — The most important constituent of the oil of caje- 
put is eajuputol, or the bihydrate of cajuputene. 

To this list might be added eucalyptol, the camphor obtained from 
Eucalyptus globulus, and the various balsams, and cymene and terpene 
volatile oils ; but these remedies have already been considered else- 
where, so far as they possess any practical importance. 

Physiological Actions. — The composition of this group of oils 
indicates the close correspondence between them and carbolic, salicylic, 
and benzoic acids. So intimate are the chemical relations of salicylic 
acid, benzoic and cinnamic acids, that the balsams might with pro- 
priety be grouped with the antiseptics, for in their physiological ac- 
tions and therapeutical applications they are equally as closely related 
as in their elementary composition. 

Of the members of this group, thymol or thymic acid has beeD 
most elaborately studied. Lewin has shown that thymol, as respects 
its influence on fermentation and putrefaction, has a positive antiseptic 
property. Its actions are similar to those acids of the same class to 
which it is so closely allied chemically, viz., carbolic, salicylic, and 
benzoic. Locally applied, thymol, just as carbolic acid, produces pa- 
ralysis of the end-organs of the sensory nerves (Lewin). 

The effects of thymol have also been studied by Baltz. He has 
ascertained that from twenty to thirty grains a day are necessary to 
produce distinct effects. Placed in contact with the fauces, it causes 
an acrid sensation, which persists. It rarely excites vomiting, but a 
large dose induces a sensation of heat about the epigastrium, and 
sometimes diarrhoea. In the majority of cases thymol causes, in about 
half an hour to an hour, sweating more or less profuse, but distinctly 
less than that produced by salicylic acid and jaborandi. The urinary 
secretion is sometimes increased. The urine presents a dark, greenish 
hue, as if it contained blood. Singing in the ears, deafness, and a sen- 
sation of constriction of the forehead, are among the nervous phe- 
nomena. The researches of Lewin and Baltz place thymol in the same 
category with eucalyptol, salicin, salicylic acid, resorcin, and carbolic 
acid. 

Myrtol. — This new antiseptic has the same relative origin as thy- 
mol ; it is derived from the myrtle and is an oil, isomeric with the oil 
of turpentine (?). It is a very active antiseptic (Gubler). It prevents 
the decomposition of urine and other putrescible animal substances, 
and has been used to destroy the fetor of decomposing pus. As an 
active parasiticide it has been used successfully against the round 
worm, and the ascarides infesting the rectum. By Laboulbene it has 
been prescribed for the expulsion of tcmia, with only partial success. 
The parasitic affections of the skin, favus, herpes, and pityriasis, are 
cured by myrtol. 

In moderate doses this agent is rather grateful to the stomach, and 



AGENTS ACTING ON THE NERVOUS SYSTEM. 397 

is a stomachic tonic or stimulant. The most important application 
made of it is in the treatment of bronchorrhcea, fetid bronchitis, gan- 
grene of the lung, etc. Eliminated by the lungs largely, it stimulates 
the tissues through which it passes, and thus a local action is added to 
the systemic effect. Chronic bronchitis, capillary bronchitis, whoop- 
ing-cough, humid asthma, etc., are maladies in which it may be ex- 
pected to afford a large measure of relief. In hematuria not due to 
acute congestion, and in passive hemorrhages in general, it has been 
used with success. 

It has long been known that oil of cloves, and indeed the essential 
oils generally, have the power to relieve a painful state of a sensory 
nerve. Inserted into the cavity of an aching tooth, they suspend the 
pain. A solution of oil of cloves in rhigolene is a nostrum for the 
cure of superficial neuralgice. ^ 01. caryophylli, ol. gaultheriaB, ol. 
thymii, aa 3 j ; tinct. benzoini, tinct. cinnamomi, aa § iv. M. Sig. : 
Apply on lint, and cover with oiled silk. 

The oil of cloves is the most effective deodorizer for sponge-tents 
hitherto employed. 

The essential oils dissolved in alcohol (essence or tincture) are 
much used to correct flatulence. 

Cajeput-oil has been used successfully in cholera, cholera-morbus, 
and nervous vomiting. I£ 01. cajuputi, 3 j ; spts. chloroformi, tinct. 
cinnamomi, aa § j. M. Sig. : A teaspoonfxd every half-hour in gly- 
cerin or sirup and water. As a parasiticide, cajeput-oil is an effective 
local application in parasitic skin-diseases — scabies, tinea, pityriasis, 
etc. — and in the form of enema, in a suitable vehicle, against ascarides 
vermicular es. 



AGENTS USED TO MODIFY THE FUNCTIONS OF 

ORGANS. 

A. OF THE NERVOUS SYSTEM. 

In this division, remedies are employed with a view to their influence 
over the functions of the nervous system. They do not immediately or 
necessarily affect the function of nutrition ; they do not enter into the 
formation of tissues ; and, having modified the functions of the nervous 
system, they are excreted from the organism in the form in which they 
entered it. It is probable that the selective action on this system is 
due to the fact that the nervous tissue is the most highly specialized 
in function, and therefore most susceptible to such impressions. 

The different parts of the nervous system are so closely united in 
function that a disturbance at any point is differentiated to other and 
often widely-separated points, and the complexus of effects is made 
up of many minor disturbances. For this reason it is quite impos- 



398 EXCITO-MOTORS. 

sible, in the present state of our knowledge, to make a classification 
which will sharply define the limits of activity of any particular rem- 
edy. Nevertheless, physiological experiment and clinical experience 
have furnished us sufficiently accurate information with regard to the 
most important actions of the remedies of this division, to justify an 
arrangement based on their most conspicuous qualities. 



THOSE EXCITING THE FUNCTIONAL ACTIVITY OF THE SPINAL 
CORD AND SYMPATHETIC. 

Electricity. — Electricity Fr. ; Electricitat, Ger. 

Forms of Electrical Force employed in Medical Practice. — Mag- 
netism, static or frictional electricity (franklinism), galvanism, fara- 
dism (electro-magnetic, magneto-electric). 

Static oe Feictional Electeicitt. 
This is obtained by friction from glass, as in the cylinder or plate, 
and by induction from the Holtz electrical machine. The last-named 
instrument is best adapted for medical use. The prime conductor of 
the electrical machine furnishes positive or vitreous electricity, and 
the rubber, negative or resinous. Various modes of electrization by 
static electricity are resorted to : 

1. By sparks. In this mode the part to be acted on is made to re- 
ceive sparks from the machine in action. 

2. The electric bath. The patient is placed on an insulated stool, 
and is charged with positive or negative electricity from the prime 
conductor, or rubber, according as he is in connection with either. 
Sparks may be drawn from the affected part by presenting the knuckles 
or a metallic conductor. A sharp, tingling sensation, followed by red- 
ness and wheals, is produced by sparks, whether received from the 
machine or drawn from the body. 

3. By the Leyden-jar. In this method, the electricity is condensed 
in the Leyden-jar, and the charge is transmitted through the part to 
be acted on. 

Owing chiefly to the physicians of Guy's Hospital, London, and 
Dr. Charcot and his pupils, Dr. Arthius and Dr. Yigouroux, of Paris, 
the use of static electricity as a therapeutical agent has been revived 
and rendered entirely practicable. Dr. Morton, of New York, and the 
author, simultaneously arrived at a method of using the Holtz electri- 
cal machine as a means of stimulating muscular contractions, and as 
a substitute for the faradic current in cases requiring such treatment. 
Before describing these manipulations it is necessary to say something 
regarding the structure of the Holtz machine. Various modifications 
of the original pattern have been introduced ; but the most successful is 



ELECTRICITY. 399 

that of Toepler. There are, however, several excellent machines 
adapted from the Holtz model to suit the views of mechanical theo- 
rists or practical electricians, which may be employed with entire confi- 
dence. The author has used with satisfaction a machine the revolv- 
ing plate of which has a diameter of fourteen inches and the fixed plate 
of sixteen inches. The power may be furnished by an electric motor, 
by a water motor or more conveniently by an assistant. In the an- 
nexed figure, the arrangement of the Toepler-Holtz is shown. This is 



Fig. 1.— The Toepler-IIoltz Electrical Machine. 

the model which the author uses, and is found to be sufficiently powerful 
for medical purposes. During the winter, when the consultation-room 
is kept at or about 70° Fahr. by artificial heat, this instrument works 
with entire satisfaction. In the late spring and summer, for the most 
part, the atmospherical conditions are such that some means are neces- 
sary to preserve the instrument from moisture. This is accomplished 
by inclosing the machine in a suitable glass case and keeping within 
it some chloride of calcium to absorb the moisture. An arrangement of 
this kind is preferred by Dr. Morton, of New York, who uses the origi- 
nal Holtz machine. 

The Holtz machine may also be employed to procure the muscular 
effects, hitherto obtained only from faradic appliances. The current 
passing between the discharging-rods can be tapped by means of a flex- 
ible wire attached to the outer coating of one condenser, and another 
flexible wire connected with the brass knob or bar which is in communi- 
cation with the interior of the other condenser. The strength of the 
current and the rapidity of the interruptions are regulated by the dis- 
tance between the knobs of the discharging-rods. At every passage of 



400 



EXCITO-MOTORS. 



a spark a muscular action takes place. If the knobs are placed very 
near each other, so rapidly do the sparks pass, that the effect produced 
is very like that obtained from a mild faradic current. Thus, by an 
arrangement of the machine which can be done on the instant, the 
actions, heretofore only obtainable from the faradic machines, are 
readily procured from the statical electrical instrument. Besides the 
effectiveness of this method, it has the advantage that it is almost pain- 
less. In no other way can strong muscular contractions be induced with 
so little pain, at least. 

Magnetism. 
Magnets are natural or artificial. The former consist of a native 
iron-ore possessed of the magnetic property ; the latter are pieces 
of steel in which the magnetic property has been induced. This 
magnetic property consists in the power to attract pieces of iron 
and steel, in maintaining a certain fixed position when suspended 
to move freely, and in attracting or repelling the extremities of other 
similar magnets. A magnet suspended, free to move, always points 
in a certain direction, north and south. That end pointing north is 
the "marked" extremity, because it has a mark, notch, or groove, 
or the letter iV, to indicate it. Because of this property, the mag- 
net is said to have "poles," or polarity. The poles behave toward 
each other in a certain definite way : Unlike poles attract / like poles 
repel, is the law. When a bar-magnet is made to approach a mag- 
netic needle moving on a pivot or suspended, there ensues attrac- 
tion or repulsion, according to the polarity of the 
extremities approximated. When a certain prox- 
imity is attained, yet some distance short of actual 
contact, the magnetic influence is exerted, and at- 
traction or repulsion, according to the pole, takes 
place. If a bar of soft iron, not magnetized, is sus- 
pended, on the approach of a permanent magnet, the 
former is seen to move toward the latter when they 
are approximated. The magnetic force is thus ex- 
erted through an intervening space : inversely as the 
square of the distance, is the law, which expresses 
this action in mathematical form. To this property 
is applied the term magnetic induction. When the 
soft iron is acted on by a sufficiently powerful mag- 
net, it ceases to be in a neutral or unexcited state, 
the magnetic property is induced in it, and for the 
time being it assumes the polar condition ; but not 
possessing the coercitive property — i. e., the prop- 
erty to retain the magnetism induced in it — soon returns to its former 
neutral condition. Steel, having the coercitive property, is the ma- 
terial out of which permanent magnets are made. The magnetic prop- 




2.— Compound 
Magnet. 



ELECTRICITY. 



401 



erty is induced in such pieces of steel by the contact of other permanent 
magnets. When once induced, the magnetic property may be readily 
destroyed by a powerful blow, by repeated scratching, and by heating. 
When a magnet is broken into several fragments, each piece has 
the same polarity. The forms of magnets are the bar and horseshoe, 
chiefly — the latter being more convenient, and also better retaining its 
power, because an armature can be kept in position. A compound 
horseshoe magnet is usually preferred for medical use, because of the 
proximity of the poles, but the straight form (Fig. 2) is also used. 

Galvanism. 
All chemical action is accompanied by electrical phenomena. The 
electricity furnished by the galvanic combinations in use is derived 




Fig. 3.— Galvanic Battery. 

from a chemical action which takes place in the elements. These 
are of various forms. Reduced to its simplest condition, a galvanic 
combination consists of two substances, one of which can be acted on 
chemically, while the other has merely the conducting property ; and 

also of a material — a fluid, usually — 
which can excite the chemical action. 
There is, then, a generating plate or 
element, usually of zinc, a conducting 
plate or element of copper or car- 
bon, usually, and a fluid or semi-solid 
which acts on the zinc, setting up 
the chemical action. When such ele- 
ments with the exciting fluid are 
placed in a glass or earthen vessel, 
the whole combination is called a 
galvanic cell or couplet, and when 
several of these are united they form 
a battery (Fig. 3). 
Galvanic cells may have a single or two fluids : the single fluid is 
not constant ; in the two-fluid, there are arrangements, partly mechan- 
ical, chiefly chemical, for securing constancy in the current. In Fig. 4 
27 




Fig. 4.— A Cell. 



40; 



EXCITO-MOTORS. 



we have two metals — zinc, s, and copper, c — united by the wire, 3f, 
placed in a glass vessel containing dilute sulphuric acid. The chem- 
ical action in such a cell consists in the formation of the sulphate of 
zinc, the water being decomposed, and hydrogen appearing at the 
surface of the copper. Such an arrangement may be defined to be a 
means of making a difference in potential between two points. Elec- 
tricity flows from the higher to the lower potential. The point where 
the chemical action is taking place — the surface of the zinc — is the 
higher potential, and hence "the current" passes from this through 
the liquid to the lower potential, the copper, which is the conducting 
plate. Now, as the current always flows from the higher to the lower 
potential, it follows that, outside of the element, the copper becomes 
positive and the zinc negative, for the current passes through the 
" conjunctive wire " from the former element to the latter. It follows 
that such an " element," or " cup," can not furnish a constant current. 
The chemical action soon rises to the maximum, the sulphuric acid 
combines with the zinc, and hence the exciting fluid is soon nothing 
more than a saturated solution of zinc sulphate, while the hydrogen 
accumulates on the copper plate. The chemical action, therefore, 
quickly subsides, and the hydrogen-bubbles hinder the passage of the 
current by the conducting plate. Elements of this kind are usually 
employed to run faradic machines, but they are not suited for gal- 




Fig. 5.— Daniell's Element. 



vanic batteries, since the tension of the current varies so much in a 
short time, and the action soon ceases. 

The two-fluid cells, in which the chemical action is less violent, 
and mechanical devices prevent the polarization of the hydrogen, are 



ELECTRICITY. 



403 



alone suited to medical uses. Only those ascertained by experience to 
be adapted to medical purposes can be referred to. One of the ear- 
liest two-fluid cell batteries constructed was that of Daniell (Fig. 5). 
The arrangement of the parts in this cell will illustrate the principles 
concerned in such galvanic combinations. The zinc and copper ele- 
ments and the two liquids are separated by a porous cup of unglazed 
earthenware. The zinc, z, is outside, and is a cylinder having a cleft ; 
about it is diluted sulphuric acid (1 part to 16 of water). The copper, 
c, is contained in the porous cup, and is surrounded by a saturated so- 
lution of copper sulphate, which is kept at the point of saturation by 
a quantity of the crystals packed around the copper element. The 
polarization of the hydrogen is prevented by chemical means, for in 
the decomposition of copper sulphate the hydrogen combines with 
oxygen to form water, while metallic copper is deposited on the copper 
element. The Daniell, as modified by the celebrated Dr. Remak, of 
Berlin, has been more widely used for medical purposes than any other 
cell, and still maintains its superiority. In this arrangement made by 
Siemens and Halske, of Berlin, and known under their name, besides 
the porous cup, a quantity of papier-mache, or paper-pulp, is packed 



fCCCCGTs* 




,; iSHII 




— Bunsen Cell. 



in between the elements, and, while the copper is surrounded by cop- 
per sulphate in solution, only water is used with the zinc. In the de- 
composition, copper is deposited on the copper element and sulphuric 
acid diffuses through into the zinc compartment. This cup is remark- 
able for the uniform tension of the current, for constancy, and for 
economy. A " gravity battery," composed of zinc and copper elements, 



404 



EXCITO-MOTORS. 



zinc sulphate solution about the zinc, and copper sulphate solution 
about the copper, and separated merely by the specific gravity of the 
respective solutions, is now much employed in telegraphy, and to a 
considerable extent in medical practice. Zinc and carbon are now 
utilized in two-fluid as in one-fluid cells. The Bunsen combination 
is a most efficient one (Figs. 6 and 7). The outer zinc plate has a 




Fig. 7.— Bunsen Battery. 



cleft, and is immersed in dilute sulphuric acid, while the carbon, of the 
variety known as gas-carbon, is contained in a porous cup with strong 
nitric acid. Here the hydrogen is intercepted by the nitric acid, ni- 
trous-acid fumes are given off, and sulphate of zinc is formed. It is 
a very powerful combination, but the fumes of nitrous acid make it 
very objectionable. Although it is not suited for medical use in gen- 
eral, it is well adapted for galvano-caustic purposes. Mr. De la Rue's 
chloride-of-silver battery is admirably well arranged for forming a 
portable or permanent combination for the medical electrician. It 
may be made of test-tubes, closed with a rubber stopper containing 
two orifices for the elements, which consist of a zinc rod and flat- 
tened silver wire. At the bottom of the tube is placed some chlo- 
ride of silver, and above this a solution of common salt. The silver 
element dips down into the chloride of silver, and above this is in- 
sulated by sheet gutta-percha. This cell has an electro-motive force 
a little more than the Daniell, and it is remarkably constant, portable, 
and unchangeable. A very efficient and at the same time economical 
cell can be constructed of a tin can, iron filings, a porous cup, and a 
rod of zinc. In the porous cup, about the rod of zinc, is put some 
common potash, and the iron fillings which form the positive element 
are packed around the porous cup. 

Besides the above, mention should be made of the two-fluid bichro- 
mate of potash cell. A solution of the bichromate in dilute sulphuric 
acid is now chiefly used as the exciting fluid in single-fluid cells ; but, 
in the two-fluid arrangement, the carbon element is placed in a porous 
cell containing a saturated solution of bichromate of potash in water 



ELECTRICITY. 405 

only, and the zinc element is acted on by very dilute sulphuric acid 
(1 to 20). The performance of this cell is in a high degree satisfactory. 
The carbon in this, as in the other galvanic cells, is gas-carbon, which 
is remarkable for its density and for conducting power. The zinc is 
ordinary commercial zinc, amalgamated. The process of amalgama- 
tion consists in first immersing the zinc plate or rod in dilute sulphuric 
acid to make a clean surface, and then rubbing it with a little mercury 
until it presents a silvery whiteness. A homogeneous surface is thus 
made, and the loss of power due to the formation of innumerable 
couplets of zinc with the impurities contained in it is thereby pre- 
vented. 

The force generated in the cup by the chemical action is termed 
electro-motive force, and it is the difference in potential between the 
two elements. The power of any combination of cups is the sum of 
the electro-motive force of each one less the difference caused by re- 
sistance in the circuit. The current from a battery has strength, ten- 
sion, and quantity. The strength is the amount transmitted in the 
unit of time, along a given conductor ; tension is the power to over- 
come resistance ; and volume is the net quantity available. There 
are various objects which offer resistance to the passage of the current. 
The circuit of a galvanic battery consists of the space between the 
elements in the cup, the conducting element, and the wire which unites 
the poles — the conjunctive wire. The current passing over this circuit 
has to overcome the resistance opposed by these several parts. The 
conjunctive wire offers a degree of resistance determined by its length 
and section. A single large cup, having zinc and carbon elements of 
corresponding size, excited by bichromate solution, will heat to red- 
ness, even volatilize a platinum wire, while twenty small medical-bat- 
tery cups connected in series will scarcely warm such a wire. Inten- 
sity, resistance, and quantity, are now given a mathematical mode of 
expression. The unit of electro-motive force is the volt, in honor of 
Yolta, and is very nearly the power of a Daniell cell, which is, hence^ 
convenient as a standard of comparison. The unit of resistance is the 
ohm, so named from the discoverer of the celebrated law. The unit 
of intensity is the ampere, formerly the weber, both the names of 
physicists, distinguished in electrical science. An ampere represents 
the quantity of electricity produced by the unit of electro-motive force 
— the volt — circulating in a conductor having the unit of resistance — 
the ohm — during the unit of time — the second. It has been practically 
ascertained that this is the quantity of electricity furnished by a Daniell 
cell, and made to pass through a hundred metres of telegraph-wire. 
The unit of capacity is the farad, from Faraday ; but, as this amount 
is much too large for medical purposes, it is the usual practice to em- 
ploy the term microfarad, which is equal to one millionth part of a 
farad. 



406 



EXCITO-MOTORS. 



There are several modes of ascertaining the current strength. The 
voltameter (Fig. 8) is an instrument for collecting the oxygen and 
hydrogen produced by the decomposition of water. The quantity of 
gas per minute evolved by the gal- 
vanic action is an absolute measure 
of the strength of the current dur- 
ing that time. This instrument, 
although not so much used as the 
galvanometer for determining cur- 
rent strength, is not without prac- 
tical utility, and it is employed by V^ 
Ciniselli and others to ascertain the 
power of any given combination be- 
fore proceeding in the operation of 
electrolysis in the treatment of aneu- 
rism. Galvanometers are more frequently used. A galvanic current 
made to traverse a wire, in the vicinity of a magnetic needle, deflection 
takes place according to the strength and direction of the current. 
This constitutes the simplest form of the galvanometer. It is really a 
galvanoscope, indicating the existence of a current and its direction, 
but not affording an exact measure of its strength. The astatic com- 
bination is much more sensitive : it consists of two needles of about 
the same strength, but placed in opposite positions as to polarity, so 
that the directive force of the earth's magnetism is neutralized (Fig. 9). 
The arrangement of an astatic galvanometer is shown in Fig. 10. To 




—Voltameter. 




I 



4- 





Fig. 9.— Galvanometer. 



Fig. 10.— Galvanometer. 



render such a galvanometer of use as a means of exactly representing 
the strength of the current, the scale must be graduated in mille-am- 
peres of absolute measurement, or millewebers. Such instruments, as 
now made, enable the operator to express in exact terms the current 



ELECTRICITY. 407 

strength ; instead of the number of cups, which affords so inexact a 
measure, the absolute galvanometer interpolated in the circuit, indi- 
cates in mille-amperes, or millewebers, the actual strength. In the 
present condition of this subject, it has become necessary to express 
in an exact way the current strength, just as medicines are carefully 
weighed. 

The mode of combining the cells of a galvanic battery is determined 
by the purpose to which it is to be applied. The circuit may be " sim- 
ple " or " compound." In the former, the elements are united zinc to zinc 
and copper to copper, so that in a battery of twenty cells so united there 
is one large zinc and one large copper element, and the resistance is at 
the minimum, the chemical action yielding a very considerable quantity 
of electricity, the most of which is available. In the compound circuit 
the battery elements are arranged in series, the zinc of one connected 
with the copper or carbon of the next, and so on throughout the whole 
number. As every conductor opposes some resistance to the passage 
of the current — in other words, there is no perfect conductor — there 
must be considerable loss of electricity. It is sometimes said that the 
quantity of electricity is determined by the size of the zinc plates acted 
on, and that intensity is the result of combining numbers of elements. 
It must be understood that intensity is the power to overcome resist- 
ance, and as the resistance offered by the human body is enormous, it 
follows that a battery for the medical application of galvanism must 
have numbers rather than size. Those battery-cells furnish the smooth- 
est current in which the internal resistance is about equal to the resist- 
ance of the human body. The zinc-carbon elements of Stohrer cause 
considerable irritation and burning, while those of Siemens and Halske 
are smooth and bland. The most experienced electricians use the 
latter for this reason. It follows, therefore, that all those devices in- 
tended to diminish internal resistance are not to be commended in gal- 
vanic batteries for medical use, how desirable soever they may be in 
batteries for economic purposes. In galvanic batteries intended for 
transportation, every consideration, except efficiency, must be sacrificed 
to portability, and various mechanical arrangements have been made 
to combine these qualities. In the Stohrer, Gaiffe, and chloride-of- 
silver batteries, the safe transportation of the cells is insured, but the 
current of such combinations is wanting in the uniformity and smooth- 
ness which are such important qualities in the permanent batteries. 

The performance of any galvanic combination may be readily as- 
certained by the law of Ohm. The intensity is directly proportional 
to the electro-motive force, and inversely proportional to the resist- 
ance encountered within the cell and on the circuit. This law is rep- 
resented in the following formula : 

i= * 



408 EXCITO-MOTORS. 

I is the symbol for intensity, E for electro-motive force, R for internal 
resistance (in the cup), and r for external resistance (on the circuit). 

E 

Or it may be stated that R = -p- ; that is to say, the resistance equals 

the electro-motive force divided by the current. The term electro- 
motive force merely means the difference in potential between the two 
poles. 

A battery, whether portable or permanent, requires a " pole-board " 
for its working. An ordinary battery of a few elements may be manip- 
ulated by a simple sliding selector and polarity changer, such as that 
now attached to the Stohrer portable arrangement ; but the permanent 
batteries of large size, such as are now employed for the office and con- 
sultation rooms of medical electricians, require more efficient arrange- 
ments. The battery of 60 to 100 elements placed in the cellar or some 
distant closet, is connected, in groups of cells, with the pole-board. 
By means of the selector, any desired number of cells can be put in 
the circuit. The pole-board should also be supplied with a current- 
changer, a rheostat, an interrupter, and resistance-coils. A water rhe- 
ostat suffices for ordinary purposes. As water is an indifferent con- 
ductor, it follows that the galvanic current has a degree of difficulty 
in passing through it ; hence, any amount of resistance can be interpo- 
lated in the circuit. The most accurate mode of introducing a meas- 
urable resistance is the resistance-coW.. This is made of German-silver 
wire of a certain length and cross-section. The resistance offered by 
such a wire to the passage of the current is directly as its length, and 
inversely as its sectional area ; that is, the longer the wire, and the less 
its size, the more the resistance to the transmission of the current. 
The unit of resistance, the ohm, is the resistance made to one volt by 
a wire two hundred metres in length. It is obvious that any number 
of ohms in resistance can be interpolated in the circuit. Resistance- 
coils of definite measures of resistance are now added to each properly 
equipped pole-board. They are especially necessary in applications of 
galvanism by the polar method. 

Faeadism, oe Electeo-Magnetism and Magneto-Electeicity. 

Faradism, so named in honor of Faraday, is induced electricity. 
When the galvanic current passes through the conjunctive wire of the 
elements of a cup, especially of a battery, it acquires new properties — 
acts on a magnetic needle, and exhibits the other properties of a mag- 
net. When the conjunctive wire is extended into a coil, coated with 
insulating material, it will act on another coil in its neighborhood, as it 
does on a magnet. The former is called the primary or inducing coil, 
and the latter the secondary or induction coil. If the latter is con- 
nected with a galvanometer, it will be found that when a current trav- 
erses the primary coil, the needle of the galvanometer is at once 



ELECTRICITY. 



409 



deflected ; but if the current continue to pass without any variations 
in the tension, the needle presently conies to rest. When the current 
is broken or interrupted, the needle is again deflected, but this time 
in the opposite direction. It follows, therefore, that the induced cur- 
rent only occurs at the opening and closing of the primary circuit : at 
the making or closing the circuit, in the opposite direction ; and at the 
opening or breaking of the circuit, in the same direction. The induced 
or faradic current is therefore a to-and-fro current, instantaneous in 
duration. It is obvious from these considerations that in the construc- 
tion of a faradic battery there must be a mechanical arrangement for 
interrupting the current in the primary circuit. The usual automatic 
interrupter is Neef's hammer, a vibratile steel spring worked by the 
magnetism of the soft-iron core. The best instruments are now pro- 
vided with a simple mechanism to give slow interruptions, an impor- 
tant matter when muscles are to be exercised. In the purchase of a 
faradic instrument for medical purposes the device to effect the slow 
interruptions should not be overlooked. 

The galvanic couplet for the primary coil is now almost always the 
zinc-carbon combination excited by bichromate solution.* The pri- 
mary or inducing coil is made of thick wire and is much shorter than 
the secondary coil. In the interior of the primary coil is placed a 
bundle of wires, each one insulated and becoming a magnet when the 
current passes. This temporary magnet attracts the hammer of the 




* Pig. 11.— Euhmkorff Coil. 

vibrator, and on the instant the current is closed and opened again. 
The so-called primary current of the faradic battery is therefore some- 

* The bichromate solution is prepared as follows : Dissolve one ounce of bichro- 
mate of potassium in eighteen ounces of hot water in an earthenware vessel. Let 
it cool, and when cold add two fluid ounces of sulphuric acid, and two drachms of 
nitric acid. It should not be used until cold, and it is, therefore, preferable to keep it 
on hand. 



410 



EXCIT0-M0T0RS. 



tiling more than that coming from the galvanic couplet ; it is re- 
enforced by the induction between the turns of the coil and by the 
magnetism of the soft-iron core. 

The coil of induction, or the secondary coil, is made of long and 
fine wire ; the longer and finer, the more intense the current. The 
Ruhmkorff coil, which is composed of miles of very fine wire, fur- 
nishes a brilliant spark sometimes several inches in length (Fig. 11). 

Electro-magnetism is the title of that mode of the force induced 




Fig. 12. 

by the action of a galvanic current on a bundle of wires within an 
insulated coil ; in other words, it is the ordinary faradic battery, ex- 
cited by a galvanic couplet (Fig. 12). Magneto-electricity, on the 
other hand, is that mode of the force induced by the action of a per- 
manent magnet. If we substitute for the cell 
a strong permanent magnet, we learn that, 
on the approach or withdrawal of the magnet 
from a coil of insulated wire, a current of elec- 
tricity is induced in the coil : on the approach 
of the magnet, in one direction ; on its with- 
drawal, in the opposite direction (Fig. 13). Thus 
an instantaneous to -and -fro current may be 
caused by the action of a magnet, just as by 
the action of a galvanic current. Out of this 
principle has developed the magneto-electric 
machine, which consists of the permanent mag- 
nets, insulated coils made to revolve about the 
poles, and a mechanical arrangement for ob- 
taining regular revolutions, and making and breaking the circuit. 
Thus, by mechanical power, the same results are produced as by 
chemical action (Fig. 14). 

The discovery of a simple commutator, by which the currents can 




Fig. 13. 



ELECTRICITY. 



411 



be collected and sent in one direction, has quite revolutionized the 
utility of this form of battery. It is now applicable to electric de- 
composition (electrolysis), to electric heating (galvano-causty), and 




Fig. 14.— Magneto-Electric Machine. 



electric lighting. Indeed, with the general use of electricity fur- 
nished by the "dynamo-machines" as a motive power, it is prob- 
able that the force in this form will be successfully applied to medi- 
cal purposes. 



Galvano-Faradlzation. — The pole-board of a finished electrical ap- 
paratus should have an arrangement for combining the galvanic and 
faradic currents, so that a simultaneous application of the two can be 
made. Proposed not long since by De Watteville, this form of elec- 
trical application has already been largely employed. "When the gal- 
vanic current is flowing through the electrode wire, the faradic is 
turned on, thus bringing into action, on a part, the effects of both. 
To impart a higher tonicity to the organic muscular fiber, to increase 
absorption of exudates, are the chief purposes to be subserved by this 
method. To any one familiar with the physiological action of fara- 
dism, it will not seem strange that this process can be really useful 
only when the electrode can be brought into contact with the affected 
tissue. The application of galvano-faradism has proved of remark- 



412 EXCITO-MOTORS. 

able utility in cases of pelvic inflammation, uterine diseases (subinvo- 
lution), and consequent displacements, and excessive proliferation of 
the connective tissue of the pelvis. The combined currents act more 
efficiently in these maladies than does galvanism alone. 

Electric Baths. — Until two or three years ago electric baths were 
only used by charlatans, but of late they have been studied from the 
scientific standpoint, and their real value determined. Water is a 
conductor, but still an inferior conductor, of electricity. When both 
poles are placed in the water — a little saline, or slightly acidulated — 
and the patient immersed, the current passes through the water inter- 
posed, and hence the resistance to be overcome will be directly as the 
thickness of the stratum. Such an application, the water being the 
medium of communication, has the same character as general fara- 
dization, or galvanization. It is a dipolar electric bath. When one 
electrode enters the water, and the other is in contact with the 
patient, the bath is monopolar. In the practice of charlatans it is 
usual, if the patient complains that he feels nothing, to place a 
metallic electrode on the skin, when, of course, a lively sense of 
burning is experienced. 

The objections to electric baths are — the necessary trouble to apply 
them ; the enormous resistance of the water ; the inequality in ten- 
sion, and the lack of precision in every case as to the point at which 
the application is to be made, as to the sudden and considerable varia- 
tions in the quantity of the electricity furnished, and the unscientific 
character of the method in every aspect. To these objections may be 
added the association of electric baths with the most baleful charlatan- 
ry. If, indeed, the method possessed such conspicuous advantages 
that considerations of that character could be disregarded, then it could 
be placed among our therapeutical resources without compunctions. 

Electro-Physiology. — Much of the supposed knowledge of this sub- 
ject is in a transition state, and will ultimately require very different 
statement. Into this doubtful region the author will not enter ; but 
there are facts of great value which should not be overlooked. 

Action of Galvanism on Motor JVerves and Muscles. — Whether a 
muscle be acted on directly by a galvanic current, or indirectly through 
a motor nerve which supplies it, the muscle is thrown into action ; but 
the action is limited to the opening and closing of the circuit if the 
tension of the current continues the same throughout. If the " de- 
scending " or " direct " current has the minimum strength to cause a 
muscular contraction, this will take place at the closing of the circuit 
only, and there will be no action at the " opening," or " interruption," 
or " breaking " of the circuit. A descending, closing-current muscu- 
lar contraction is always greater than the opening. The rule is differ- 



ELECTRICITY. 413 

ent in the case of the " ascending " or " indirect " current. The feeblest 
strength of current, passing in the inverse direction, which will cause 
a muscular contraction, induces it only at the opening of the circuit, 
but, if a strong current is used, both at the opening and closing. Di- 
rect excitation of a muscle by galvanism causes more powerful mus- 
cular contractions than indirect. Such are the results of galvanic 
stimulation when the motor nerves are uncovered by tissues, and are 
directly acted on by the electrodes. If, however, motor nerves and 
the muscles are acted on through the tissues covering them, the most 
energetic contractions are induced by inverse or ascending currents, 
and at the closing of the circuit. When a motor nerve supplies by 
separate filaments two muscles, stimulation of one filament causes con- 
traction of the muscle to which it goes, but contraction of the other 
muscles also takes place. To the latter is applied the term induced 
contraction. If a motor nerve is stimulated again and again by a 
direct current, finally its excitability — that is, its power to contract on 
irritation — is exhausted ; then the excitability may be restored by the 
action of an inverse current. By thus alternating in the direction of 
the current, the muscular irritability may be alternately destroyed and 
restored for a long time, if not indefinitely. To these phenomena 
has been applied the term voltaic alternatives. 

Action of Faradism on Motor Nerves and Muscles. — A faradic 
current, whatever its direction, stimulating a motor nerve, causes con- 
traction of the muscles innervated by this nerve. If the interruptions 
in the primary circuit are slow, the muscles have time to contract and 
relax ; but when the interruptions are rapid, the muscles are kept in 
a condition of tonic contraction, or are tetanized. Long-continued, 
powerful faradic stimulation of a motor nerve exhausts its irritability. 
Muscles directly acted on by a faradic current contract energetically, 
but repeated over-stimulation will fatigue and ultimately destroy their 
contractility. When, however, muscles are in this condition of fatigue 
and exhaustion, from faradic stimulation, their proper functional state 
may be restored by passing a continuous galvanic current through 
them. If not too long applied or too powerful in action, faradic ap- 
plications improve the nutrition of muscles, and through this increased 
activity of the circulation there occurs a rise of temperature, generally. 

Hie Polar Method as applied to the Reactions of Motor Nerves and 
Muscles. — This important method of examining the condition of motor 
nerves and muscles must be understood, to rightly appreciate the 
modern mode of electro-diagnosis. As certain terms, having technical 
meanings, are much used in this connection, it is necessary to define 
them before proceeding to describe the phenomena. Anode is the 
term applied to the positive pole, cathode to the negative pole, and 
the adjectives, anodal, relating to the anode, and cathodal, relating to 
the cathode. As the polar method had its origin in Germany, the 



414 EXCITO-MOTORS. 

symbols now used to indicate electrical reactions are taken from Ger- 
man words. Charcot in France, Buzzard in England, and the Ameri- 
can writers in general, have adopted the German formulae, so now 
their use is universal. 

The polar method consists in exciting nerve or muscle with one 
pole, while the other rests on some indifferent spot, as the sternum, as 
advised by Erb. We are here concerned with the normal or physio- 
logical state ; hereafter, the pathological conditions will be given. 
The normal formulas consist in the reactions which ensue on polar 
stimulation, nerves and muscles being healthy. When the current is 
closed by applying the cathode to the nerve or muscle to be excited, 
the symbols are Ka S (Ka, Kathode ; S, Sckliessung, closing). When the 
current is opened or broken by removing or disconnecting the cathode, 
the symbols are Ka O (Oeffnung, opening). Corresponding symbols 
are used in respect to the anode. Thus, the words anodal closing are 
An S, and anodal opening, An O. To express muscular contraction 
the symbol is Z (Zuckung) ; a strong contraction is Z' ; for a weak 
contraction, z, and for a tetanic contraction, Te. In the physiological 
state, the muscular contractions as induced by the polar method are 
characteristic, and can be expressed in the symbolic language now 
employed for the purpose. It is to be observed, in the first place, that 
the cathode or negative pole has more power to induce muscular action 
than the anode or positive pole. 

The cathode has more effect on closing the circuit ; whereas the 
anode acts more powerfully on opening or breaking the circuit. 

The normal formulae of muscular contractions induced by the polar 
method may be arranged in three grades : 

In the first grade, the weakest current having power to induce any 
contraction causes it on cathodal closing — whence the formula Ka 
S Z ; and no action takes place from the anode. 

In the second or intermediate grade, the strength of current is 
sufficient to cause strong cathodal closing contraction (Ka S Z'), but no 
opening contraction ; whereas, on anodal opening and closing there 
are feeble contractions — whence An S z, and An O z. 

In the third grade, which is the highest, the current causes on 
cathodal closing a tetanic contraction, Ka S Te, and a feeble contrac- 
tion on cathodal opening Ka O z ; whereas, there occur decided con- 
tractions on anodal opening, An O Z, and on anodal closing, An S Z. 

Such are the normal formulas — such is the normal behavior of 
muscles ; but in disease, as we shall subsequently learn, these formulae 
may be much changed, may be even entirely reversed. 

Action of Galvanism on Non-striated Muscles. — The physiologi- 
cal differences in the action of voluntary and organic muscular fibers 
are well exhibited in the results of galvanic stimulation. Instead of a 
prompt, almost instantaneous muscular contraction, characteristic of 
the voluntary fiber, a slow vermicular motion is set up in the involun- 



ELECTRICITY. 415 

tary, and this movement is propagated from the point of stimulation 
by a rhythmical action. 

Action of the Galvanic Current on the Brain and Spinal Cord. — 
Until the experiments of Fritsche and Hitzig, Ferrier, Nothnagel, 
and others, within a few years past, the electric excitability of the 
brain had not been admitted. It seems now to be established that 
certain areas of the cortex cerebri are anatomically associated with 
certain muscular groups. These facts have been ascertained by direct 
stimulation of these areas of the cortex by galvanic (Fritsche and 
Hitzig) and faradic (Ferrier) applications. Can the intra-cranial or- 
gans be reached through their investing tissues ? This is the most im- 
portant question, and to this, fortunately, we are able to reply in the 
affirmative. Erb was the first to prove the transmission of a galvanic 
current through the brain, and now the fact is universally admitted. 

On electric stimulation of the cord, results are produced accord- 
ing to the functional powers of the part — pain when the sensory tract 
is irritated, and muscular movements when the motor is acted on. 
Hence, the statement of Erb, that these effects may be due to stimula- 
tion of the nerve-roots, has a high degree of probability. In the spi- 
nal cord, as in the nerves, the inverse or ascending current causes more 
decided effects. 

Electric excitation of that part of the cord between the fifth cervi- 
cal and tenth dorsal vertebrae causes dilatation of the pupil, whence 
this region is known as the cilio-spinal region. The explanation of 
this fact is, that in this part of the cord originate filaments of the 
sympathetic, connected with the cervical ganglia. In the lumbar part 
of the cord is a similar center, related to the genital apparatus, and 
hence called the genito-spinal region. 

Action of the Galvanic and Faradic Currents on the Pneumogas- 
tric. — A weak galvanic current sent through the pneumogastric, in- 
creases the force and rapidity of the heart's movements ; but a strong 
current arrests the heart in the diastole. After division of the nerve, 
stimulation of its upper or central portion arrests respiration in the 
movement of inspiration, but does not influence the heart ; but a 
strong current acting on the lower or distal portion of the nerve stops 
the heart in diastole. A descending galvanic current, passed through 
the pneumogastric nerve, suspends the contractions of the stomach. 
A faradic current directly applied to the pneumogastric, before and 
after division of the nerve, produces the same results, but more decid- 
edly ; applied through the tissues, it has no apparent effect. 

Action of Galvanism and Faradism on the Sympathetic System. — 
Covered by the tissues, the ganglia and fibers of the cervical sympa- 
thetic are not acted on by faradic and static electricity, but even a 
weak galvanic current does affect them. Applied directly to the sym- 
pathetic nerves, the effect of faradism is tetanizing, and the ves- 
sels receiving their innervation from this source contract very 



416 EXCITO-MOTORS. 

strongly. Applied through the tissues, the faradic current has little 
or no effect. 

The kind of action set up by galvanism, and the differences due to 
the direction in which the current is passing, have been much disputed. 
The author believes that the experiments and the deductions of Onimus 
and Legros correctly represent the actual condition. They hold that 
the direct or descending current, by increasing the normal wave-like 
or vermicular motion of the muscular layer of the vessels, increases the 
amount of blood passing through them ; but a very strong galvanic cur- 
rent — forty to sixty milliampere-metres — will tetanize the organic mus- 
cular fiber, as we have ascertained by actual investigation, and in this 
way lessen the quantity of blood passing. 

Electko-Diagxosis. — For diagnostic purposes both galvanic and 
faradic currents are necessary. The polar method has been applied with, 
great success for determining the condition of nerve and muscle. As 
has been stated, the pole intended for excitation must be placed over 
the nerve or muscle to be acted on, while the other rests on some in- 
different point — for the upper extremity and trunk, the sternum is 
convenient. If the operator has no assistant, an interrupting handle 
of the electrode is useful, or an automatic interrupter may be attached 
to the pole-board, or the interruptions may be effected by simply ap- 
plying or removing the electrode. 

The normal formulas of nerve and muscle actions have been set 
forth ; in disease these formulae are altered — may be, even entirely 
reversed. It suffices now to state that when a faradic — an induced — 
current is applied to a muscle, or to the motor nerve supplying it, con- 
traction of the muscle takes place. This is called faradic excitation, 
and it is direct when the contraction is caused by application of the 
electrodes to the muscle itself, and indirect when the motor nerve is 
acted on. When galvanism is used to produce these effects, the term 
applied is galvanic excitation, and this is direct or indirect. 

The Diagnosis of Paralysis. — When the paralysis is limited to a 
group of muscles, to one member, or to one side, the behavior of the 
paralyzed muscles is compared with the normal. If, however, as is 
comparatively infrequent, symmetrical muscles are paralyzed, their 
condition must be contrasted with that of another healthy subject. 

The paralysis of muscles may be complete, and yet they react in a 
normal manner. In other cases, there may be merely quantitative 
changes ; that is, there is a mere increase or diminution of electric 
excitability, the polar reactions conforming to the normal, in order. 
In the third group, the paralyzed muscles are found to be changed, 
not only quantitatively but qualitatively, in respect to their responses 
to the electrical excitation. If the muscles respond in a normal man- 
ner to both forms of current, it may be concluded that the spinal cord 
connected by nerve-fibers to the paralyzed part is free from disease. 



ELECTRICITY. 417 

The changes in respect to the electric excitability, in some cases of 
paralysis, consist merely in a quantitative increase to both currents : 
the muscles react to a less strength of current, or more energetically 
to the same strength. In the latter, while the normal formula is de- 
veloped by acting on the healthy muscles, on the paralyzed side the 
reaction is more decided, as indicated by a cathodal closing contrac- 
tion (Ka S Z) occurring with a very weak current, or Ka S Z becoming, 
on the application of the same current, a tetanus (Ka S Te) ; also indi- 
cated by the early appearance of an anodal opening contraction (An O Z) 
and the prompt appearance of a cathodal opening contraction (Ka O Z). 
A hemiplegia of recent occurrence, some cases of spinal paralysis at 
a very early stage, and very rarely the earliest manifestations of pa- 
ralysis from nerve-lesions, are illustrative of this state. 

The usual condition for which the electrical currents are employed 
in diagnosis is diminution or loss of electric excitability. Spinal, 
motor-nerve, and muscular lesions are the most important. "Reac- 
tions of degeneration " is the happy term employed by Erb to signify 
the changes in the electrical reactions. Owing to disease of the cord, 
or of the motor-nerve trunks, degenerations of tissue ensue, and hence 
the term. For a very brief period, in some cases, there is an increase 
of electrical excitability, but a decline then quickly ensues. As re- 
gards faradism, the strength of current necessary to cause a contrac- 
tion of the affected muscles must be constantly increased, and in a 
short time no strength of current will cause the least movement. The 
normal formula for the galvanic current is changed, pari passu, with 
the decline of faradic excitability. First, the cathodal closing tetanus 
ceases (Ka S Te), then anodal closing contraction (An S Z), and finally 
cathodal closing (Ka S Z) can be excited only by the strongest cur- 
rent. These changes rep-esent a gradually increasing atrophy of the 
muscles, and the final cessation of the cathodal closing contraction 
signifies an extreme degree of atrophy, and the disappearance of the 
muscular elements. 

In the condition known as the reactions of degeneration, it is im- 
portant to distinguish between the reactions of the motor nerve and of 
the muscles. It has been already pointed out that, whether the mo- 
tor nerve supplying it, or the muscle itself is acted on, muscular con- 
tractions take place. In the changes which ensue in cases of paralysis, 
the state of the nerve is separable from that of muscle. If the paral- 
ysis is due to a lesion of the nerve-trunk — to an inflammation of the 
nerve, for example — there may be a brief period when, as above stated, 
the electric excitability is heightened ; but, as the nerve undergoes de- 
generative atrophy, there ensues a quantitative decline in the response 
to electrical excitation, to both faradic and galvanic, and by the twelfth 
day, sometimes earlier, it has usually entirely disappeared, if the le- 
sions have proved destructive and irremediable. On the other hand, 
28 



418 EXCITO-MOTORS. 

if the injury done is less, and is remediable, the electric excitability is 
modified only, and not lost. When recovery from the injury, or in- 
flammation of the affected motor nerves takes place, the muscles inner- 
vated will respond to the impulses of the will, long before they react 
to faradic or galvanic stimulation. 

When the spinal cord is the seat of disease, as in infantile paralysis, 
glossolabiolaryngeal paralysis, progressive muscular atrophy, etc., the 
paralyzed nerves and muscles exhibit most characteristic electrical re- 
actions. As regards the motor nerves, in two or three days, usually, 
after the paralysis has manifested itself, a regular and steady quanti- 
tative decline in excitability to both forms of current takes place, and 
by the end of the second week, usually, and sometimes by the end of 
the first week, no strength of current applied to the nerve will cause 
muscular contractions. At first, cathodal closing ceases, then anodal 
closing, and finally anodal opening. 

The muscular reactions are much changed from the normal. The 
muscles, in about a week after the paralysis appears, begin to decline 
in their excitability to the faradic current, and, at the end of two 
weeks, it is totally lost, and they cease to respond to any strength 
of application. If regeneration of the diseased nerve-tissue can be 
effected, restoration of the faradic excitability may be accomplished, 
but to a less extent than before. 

The phenomena connected with the galvanic excitability are very 
different. For the first week of the paralysis the response of the mus- 
cles to the galvanic current declines, as it does to the faradic ; but, 
after the second week, a remarkable change ensues : then the galvanic 
excitability begins to increase, and with this there occur qualitative 
changes in the order and mode of muscular contractions. These con- 
sist in a gradual increase of the anodal closing contraction, which soon 
equals if it does not surpass the cathodal closing, and the cathodal 
opening contraction declines in the same measure. In other words, an 
actual reversal takes place of the normal formulas. If the degenera- 
tions continue, and the muscular elements are finally destroyed, the 
reactions ultimately cease, the last to disappear being a very feeble 
anodal closing contraction. Such are the reactions of degeneration. 
They occur in cases of spinal paralysis, when the disease in the cord 
is in direct anatomical association with the paralyzed parts, and in 
cases of peripheral paralysis when due to injury or disease of nerve- 
trunks. The so-called infantile paralysis is an illustration of the for- 
mer, and facial paralysis of the latter. When the disease is situated 
in the cord above the point from which nerves are given off to the 
paralyzed members, there is no change in the law of muscular contrac- 
tion. When, for example, a transverse myelitis exists entirely above 
the dorso-lumbar enlargement of the cord, the muscles of the lower 
extremities, although paralyzed, react normally to the faradic and 



ELECTRICITY. 419 

galvanic currents. Again, in disseminated myelitis there are groups 
of muscles that react in accordance with the law of normal contrac- 
tion, and other groups that manifest the reactions of degeneration — 
the former being in anatomical connection with a healthy part of the 
cord ; the latter with a diseased area. It follows, therefore, that a 
proper electrical examination should be made as a means of diagnosis 
in the diseases of the nerve-centers. 

Diagnosis of Sensibility. — By means of the faradic brush, and 
pointed electrodes closely approximated, the state of sensibility of the 
skin may be readily marked out. The skin must be carefully dried 
to prevent diffusion of the current, and then the brush or electrodes 
conveying the induced current must be carefully passed over the sup- 
posed anaesthetic and analgesic area, and the outlines of the affected 
surface thus ascertained. 

The galvanic current by the polar method has been very success- 
fully applied to determine the state of the auditory nerve. The pole 
intended for excitation is introduced through a suitable non-conduct- 
ing speculum into the ear, previously filled with warm water, and the 
other pole is placed on the mastoid process, nape of the neck, or any 
indifferent point. Brenner, of St. Petersburg, who has contributed 
the most of the exact knowledge now in our possession regarding these 
auditory reactions, has invented resistance-coils to be utilized in these 
researches. A strong current, reduced to the necessary point for act- 
ing on the auditory nerve by the introduction of sufficient resistances, 
is passed through the organ, and the resulting sounds, subjective, and 
audible, of course, only to the patient, indicate the condition of the 
nerve. These sounds, whistling, singing, roaring, etc., have been re- 
duced to formulated expressions. Although there are differences of 
opinion in regard to the real value of these auditory reactions, it seems 
to be now well established that Brenner's method and formulae are 
correct in the essential details. 

The state of gustatory sensibility is most correctly ascertained by 
galvanic stimulation of the end-organs of the nerve. For this purpose 
a pointed electrode, the positive and negative as closely approximated 
as possible, is carefully passed over the area of distribution of the sense 
of taste, and its condition noted. 

Feigned paralysis may sometimes be detected by faradic stimula- 
tion of the muscles, and feigned insensibility by a strong current. 
Hysterical paralysis is remarkable for the absence of electro-sensibility 
and the presence of electro-contractility. 

Therapy. — Manipulation. — Electrodes for the application of gal- 
vanism or faradism are of various shapes and materials. The best, 
probably, is a disk of carbon covered with wash-leather. A metal 
disk covered with soft sponge is also much used. The size depends 
on the purpose to which applied. When large volume and high in- 



4-20 EXCITO-MOTORS. 

tensity are the qualities of the current* the electrode should be of large 
size, of soft sponge, well moistened. For application to small muscles, 
Duchenne's olive-shaped, curved electrodes are most suitable ; and to 
individual nerves, metal buttons of various shapes covered with wash- 
leather. The instrument-makers are now supplied with all forms and 
kinds of electrodes, so that the operator can always obtain what form 
of electrode soever he may desire. 

When it is intended to act on parts beneath the skin, the electrodes 
and skin should be well moistened, for the conductivity of the tissues 
is in direct ratio with the amount of water they contain. On the other 
hand, if the skin alone is to be acted on, it should be well dried to pre- 
vent diffusion of the current. When weak galvanic applications are 
made, but little tingling is felt by the patient, and hence he may sup- 
pose that no curative effect is produced. Under such circumstances, 
it were better to add a little salt to the water with which the electrodes 
are moistened. 

Electrical applications should always be made to the affected part, 
and also to those parts in which decided symptoms are felt. The 
principle of localized electrization, as established by Duchenne, was a 
most important advance. Next, the polar method did much to give 
exactness to methodical applications. When the poles have a fixed 
position, and are not moved, the application is said to be stabile, and, 
when moved over the part operated on, labile. If the direction the 
galvanic current is taking is parallel to the nerve-current, or from the 
center toward the periphery, the application is said to be direct, or 
descending ; if in the opposite direction, indirect, or ascending. 

General elect?'izatio?i is a term used to indicate the application of 
either current to the whole surface of the body — one pole placed on 
the nape of the neck, or to the feet, and the other passed over the 
whole surface of the body. Central galvanization is a term invented 
by Beard and Rockwell to signify applications to the cervical sym- 
pathetic, to the pneumogastric, to the cervical and dorsal parts of the 
spinal cord, and to the solar plexus. If one pole be placed on the 
seventh cervical vertebra, and the other in the fossa behind the angle 
of the jaw ; if the former be kept in this position, and the latter put 
on the epigastrium ; and, lastly, if the first be moved down the spine 
to a point opposite the second — there will be brought into the circuit, 
successively, the ganglia of the cervical sympathetic and their cardiac 
branches, the pneumogastric, spinal accessory, phrenic, the semilunar 
ganglion and solar plexus, and the spinal cord. 

In what mode soever applied, and at what point, more or less dif- 
fusion of the current takes place. Although the current flows from 
the higher to the lower potential by the most direct route, a greater 
or less deflection is caused (diffusion) by the resistance encountered on 
the circuit. 



ELECTRICITY. 421 

Magneto- Therapy. — The force furnished by the magnet — mag- 
netic polarity — produces distinct effects when applied to plants and to 
animals, and it has been utilized in the treatment of diseases. It has 
been shown by Dr. Vansant that the south pole of the magnet ap- 
plied to a sensitive surface causes pain, while the north pole is free 
from this action, and indeed relieves the pain caused by the former. 
Small animals are similarly affected, the south pole causing excite- 
ment, and the north pole sedation. Sometimes remarkable curative 
results are obtained by the application of magnets in neuralgia and 
in chorea ; but they often fail utterly. In hysterical affections, hemi- 
anesthesia, contractures, etc., the results are more- constant, and, in- 
deed, are often very striking. It is quite impossible to separate the 
influences due to the imagination from the direct action of the magnet. 

The form of magnet used in medical practice is chiefly the horse- 
shoe, and, to obtain sufficient power, several permanent magnets are 
clamped together. The magnetic pole with which the effect is in- 
tended to be produced may be gently stroked along the course of the 
nerve in cases of neuralgia, or the magnet may be fastened on the part 
by suitable straps. The duration of the application will be determined 
by the effects. In some cases the result is little short of magical ; in 
others, apparently of the same character, no effect follows. 

Galvano - Therapy. — The most important curative results are 
wrought by galvanism. As a rule, the large, two-fluid elements of 
the permanent battery are much more effective therapeutically than 
the small portable combinations. In the Siemens and Halske modifica- 
tion of the Daniell cup, which is so much employed by German electro- 
therapeutists, and which the author also uses, the resistance within 
the battery is very great, nearly equal, indeed, to the resistance of the 
body. Hence, the current is smooth and uniform, and hence, also, the 
good results obtained from it. 

Allbutt made a number of experimental observations at the West 
Riding Lunatic Asylum on the therapeutical effects of electricity (gal- 
vanism) in psychical disorders, and he sums up his results as follows : 
Marked improvement in acute primary dementia ; distinct improve- 
ment in mania, atonic melancholia, and perhaps recent secondary de- 
mentia ; no change observed in chronic dementia and some cases of 
melancholia, and an unfavorable effect in hypochondriacal melancholia, 
and perhaps brain-ioasting. In the cases reported by Allbutt, the cur- 
rent was sent through the head and through the cervical sympathetics. 
Benedict (page 222) reports three cases of mental disorder improved 
by galvanism. 

I have observed excellent results in the mental and other symp- 
toms — confusion of mind, impaired memory, hypochondriasis, vertigo, 
etc. — which result from imperfect nutrition of the brain, caused by 
atheromatous degeneration of the cerebral vessels. My method of 



422 EXCITO-MOTORS. 

application has consisted in transverse transmission of galvanism 
through the brain, using a current of sufficient intensity merely to 
cause slight giddiness, a faint metallic taste, and barely perceptible 
flashes of light. 

Galvanization of the brain and of the cervical sympathetics is one 
of the measures to be resorted to in acute active or passive congestion 
of the brain. Wakefulness, when not reflex in origin, and when de- 
pendent simply on the state of the vascular supply, is often relieved 
by galvanization of the brain. Insomnia may be dependent on either 
active or passive congestion. In the first case a continuous current of 
moderate intensity should be passed through the superior ganglion of 
the sympathetic — the positive pole being placed in the auriculo-max- 
illary fossa, the negative on the seventh cervical vertebra ; in the 
second case a mild current should be transmitted transversely through 
the brain, and be slowly interrupted. 

To promote absorption of the clot in cases of cerebral haemorrhage, 
and to relieve the collateral oedema in embolism of the cerebral arte- 
ries, very mild galvanic currents may be emjrioyed. Caution is neces- 
sary, however, in employing galvanism in such cases. Strong currents 
and lengthened applications may do serious mischief ; but the author 
believes, with Remak, that judicious application of galvanism will be 
useful. The immediate effects of the embolism, or of the haemorrhage, 
should be allowed to subside before commencing the use of electricity, 
and, if there be much headache and vertigo, the greatest circumspec- 
tion will be necessary. 

In hemiplegia the constant current may be applied to the brain, 
for the purpose of improving its nutrition, and the faradic or induced 
current to the muscles, to prevent wasting and loss of function from 
disuse. If the temperature of the paralyzed parts is lowered, the skin 
discolored and roughened, the muscles weak and flabby, much im- 
provement in all these particulars will follow faradization. Large elec- 
trodes, well moistened, should be used, and all the muscles should 
in turn be made to contract — one pole being placed over the motor 
nerve, the other over the bellies of the affected muscles. In cases of 
hemiplegia, when the nutrition of the skin and muscles has been im- 
proved to the extent which faradization can accomplish, no advantage 
can accrue from further persistence in the applications. In faradizing 
the muscles in a case of hemiplegia, a current of just sufficient inten- 
sity to cause contractions should be used. Tetanic cramps fatigue the 
muscles, and are harmful. The so-called " late rigidity " — the muscu- 
lar contractions which ensue after a time in hemiplegia, and which 
occur chiefly in the forearm and hands — is best treated by a contin- 
uous current to the contracted flexors, and an interrupted or faradic 
current to the relatively weaker extensors. 

In recent affections of the spinal cord, as a rule, electricity is not 



ELECTRICITY. 423 

indicated. In chronic myelitis, syphilitic diseases of the meninges, 
after a course of suitable specific treatment, and in some of the sequelae 
of acute meningitis, much good may be accomplished by the galvani- 
zation of the spine and the paralyzed muscles. The wasting of the af- 
fected muscles may be arrested and their nutrition raised to the nor- 
mal, and the paralysis of the sphincters may, in many cases, be relieved. 
When the electro-contractility of the muscles is not impaired, and 
when they have not wasted, no good is to be accomplished by stimu- 
lating them with the electrical current. 

That very troublesome disorder, spinal irritation, with its extensive 
irradiations of nerve-pain, is much benefited by an inverse galvanic cur- 
rent, according to Hammond, and this observation I have been enabled 
to confirm by my own experience. Hysterical paralysis of the extremi- 
ties, accompanied or not with anaesthesia or hyperesthesia, should be 
treated by galvanization of the spine and faradization of the muscles. 

In paralysis from lead (dropped wrist), the muscles may be so far 
atrophied as not to respond to faradization, but may react when stimu- 
lated by a slowly-interrupted galvanic current. When this condition 
exists, the interrupted galvanic current must be first employed, and the 
cure be completed by the faradic current when the muscles are so far 
improved as to react to the latter. 

The best example of a peripheral paralysis is that of the muscles 
of the face, from disease or injury of the facial nerve. From exposure 
to cold, or disease of the ear, or traumatic injury, the nerve is damaged, 
and the muscles to which it is distributed are paralyzed. In accordance 
with the law already given, such muscles do not respond to the faradic 
current, but do react to galvanism. The positive pole is placed over 
the pes anserinus, or on the mastoid process, and the negative is made 
to pass over the peripheral expansion of the nerve, so that all the mus- 
cles innervated by the nerve are brought into action. A current of 
sufficient intensity to induce muscular contraction must be employed. 
As in the case of other peripheral paralyses, after a time the af- 
fected muscles recover their power of response to faradism, when this 
form of current may be used to complete the cure. If the nerve has 
not been irremediably damaged, and if the paralysis has not existed 
so long that the electro-contractility is lost in consequence of atrophic 
degeneration of the muscles, a cure of facial paralysis may be effected 
by a persistent use of electricity. 

Certain of the ocular paralyses, as of the third, fourth, and sixth 
nerves, are often cured by electricity (interrupted galvanic current). It 
is necessary, in order to obtain a successful result, that the remedy be 
employed in suitable cases. When these paralyses are dependent on 
cerebral tumors, syphilitic gummata, exostoses, etc., electricity can not 
be expected to cure ; but the paretic state of the muscles, left after 
the removal of the gummata, may be promptly relieved by galvaniza- 



424 EXCITO-MOTORS. 

tion. The functional states of the above-mentioned nerves, of which 
paralysis may be a symptom, will certainly be cured by electricity. 
Faradism may sometimes succeed when galvanism fails in these cases 
(Althaus). 

Cases of aphonia, when dependent on paralysis of the vocal cords, 
are sometimes cured by a single application, and few, indeed, resist the 
proper use of galvanism. The larynx may be faradized externally ; 
the recurrent laryngeal may be galvanized by placing one rheophore 
over its trunk and the other over the larynx, or, what is better, an in- 
tra-laryngeal electrode (Mackenzie's) may be used. 

Paralysis of the bladder and of the sphincter ani, even when 
symptomatic of spinal affections, may be greatly benefited, and the 
condition of the patient rendered much more comfortable, by an inter- 
rupted galvanic or faradic current applied by suitable insulated elec- 
trodes. Idiopathic cases of these affections may be cured in this way. 
Constipation, due to atony of the muscular layer of the large intestine, 
can be overcome by the same means. An insulated electrode is intro- 
duced into the rectum, and a large sponge-covered rheophore, well 
moistened, is passed over the abdomen so as to bring every part of the 
large intestine within the circuit. 

The failure of respiration in opium narcosis can be most success- 
fully obviated by faradization of the muscles of respiration. A strong 
faradic current is one of the most effective means of causing uterine 
contractions in cases of post-partum haemorrhage. 

In certain of the " myopathies of spinal origin" but not in all of 
them, electricity gives excellent results. The most decidedly curative 
results are obtained in infantile jiaralysis. The electrical treatment 
should be begun early, but after the subsidence of all inflammatory 
symptoms. Good results may be looked for if the electro-contractility 
of the muscles is not lost, and if important changes have not occurred 
in the joints. In many cases the affected muscles, although not atro- 
phied, do not respond to the faradic current, but will to the interrupted 
galvanic. The latter should therefore be used until the muscles are 
put into a condition to respond to the former. Besides galvanization 
and faradization of the paralyzed muscles, the electrical treatment 
should include galvanic spinal-nerve and plexus-nerve currents. Thus 
far but little benefit has accrued from the electrical treatment of pro- 
gressive muscular atrophy. If the initial change in this malady were 
myopathic (as asserted by Friedreich), good results from localized 
faradization might be obtained. The author's most recent experience 
as to the curability of this disease by electricity is not in accord with 
Onimus and Legros's, who declare that it is without avail in this dis- 
order, for it does appear to have the power, in some instances, of 
arresting its progress. Posterior spinal sclerosis is sometimes retarded 
in its course and progress by electricity, and galvanization of the spine 



ELECTRICITY. 425 

lesseDS somewhat the severity of the neuralgic pains which belong to 
this malady. Recently it has been shown that persistent use of the 
faradic brush to the spine, body, and extremities, is in suitable cases 
remarkably effective. Of all the remedial means now employed, this 
is the most promising, for Strumpf, of Dusseldorf, who has revived 
this treatment, reports not only amelioration but apparent cures of 
this before intractable disease. 

Nothing is more certain in therapeutics than the relief to pain by 
galvanization of the affected nerve or nerves. In tic- douloureux de- 
cided relief to the pain is obtained by electrical applications to the 
fifth, and a permanent cure not unfrequently results in those cases 
belonging to the category of the essential neuralgia, so called. The 
best method of application is that advised by Onimus and Legros, 
which consists in placing the positive pole on the point of emergence 
of the affected nerve, and the negative over the superior ganglion of 
the cervical sympathetic. About ten elements of Siemens and Hal- 
ske is the proper strength, and five to eight minutes the proper time, 
for these applications. This method of treatment is, according to 
Frommhold, the most effective remedy for migraine or hemicrania. 

In cervico-brachial neuralgia, and in sciatica, excellent results are 
obtained by galvanization of the affected nerves. The positive pole 
should be placed over the point of emergence of the nerves from the 
cord, and the negative over the main divisions of the peripheral expan- 
sion. Both labile and stabile currents may be employed. A current 
from thirty elements will usually be required. The electrodes should 
be large sponges well moistened. In old cases of neuralgia, a needle 
such as is used for acupuncture, but insulated to near its point, may be 
introduced down to the neighborhood of the nerve-trunk and attached 
to the positive pole, while the negative sponge-electrode may be passed 
over the course of the nerve. This mode of galvanization is especially 
to be recommended in old cases of sciatica. A daily seance of from 
five to fifteen minutes is required usually in cases of neuralgia. The 
cure is much more difficult, and the applications must be continued 
over a much longer period of time, in those cases of neuralgia depend- 
ent on neuritis. Decided amelioration and even cure may be hoped 
for by sufficiently prolonged applications, when the nerves are so far 
altered that induced currents do not cause any muscular contractions. 
Some of the most satisfactory results have been obtained from galvan- 
ization of the uterus in uterine and ovarian nerve-pain. 

In certain kinds of muscular spasm the galvanic current has un- 
questioned utility. Cases of spasmodic wry -neck (torticollis) of recent 
origin, due to " rheumatism," are quickly relieved by galvanization by 
stabile currents of the affected muscles, and faradization of the opposed 
muscles. Old cases of wry-neck and convulsive tic of the face, and 
writer's cramp, are not benefited by this treatment. Cases of chorea 



426 EXCITO-MOTORS. 

have been cured by static electricity, but little benefit has been derived, 
according to the author's observation, from galvanism or faradism. 

Galvanism is sometimes of great service in epilepsy, but no exact 
indications for its use can be laid down. Obviously it can only be ser- 
viceable in idiopathic epilepsy. The applications should include the 
brain (transverse current from mastoid process), the cervical sympa- 
thetic, and those nerve-trunks along which an aura is transmitted. 

The author has witnessed some remarkable results from the galvan- 
ization of the pneumogastric nerves, and as conspicuous failures from 
the same practice, in spasmodic asthma. Even in those cases not per- 
manently improved, great relief to the difficult breathing is experienced 
when the current is passing. The positive pole is placed over the pneu- 
mogastric, beneath the mastoid process, and the negative pole is applied 
to the epigastrium. Faradism is not serviceable in this disease. 

Exophthalmic goitre, a disease of the sympathetic system and 
manifested objectively by proptosis, goitre, and palpitation of the heart, 
is cured by galvanization of the cervical sympathetic and of the pneu- 
mogastric, and by applications to the eyes and thyroid gland, when it 
is merely functional in character. 

There can be no reasonable doubt of the influence of electricity 
over the nutritive functions. Beard and Rockwell employ the method 
termed by them " general electrization," which consists in faradic ap- 
plications to the surface of the body, "one pole, usually the negative, 
being placed at the feet or the coccyx, while the other is applied all 
over the surface of the body." They formulate their principles in 
these applications as follows : " Constitutional diseases are better 
treated by general, and local diseases by localized electrization." Ac- 
cording to Benedikt — and in this view electricians are generally in 
accord — the true method of using electricity consists in making appli- 
cations to the affected part or organs, and, to this rule may be added, 
to those parts or organs also in which symptoms are felt. 

General electrization is useful " in those diseases that are dependent 
on, or associated with, impairment of nutrition and general debility of 
the vital functions, such as nervous dyspepsia, neurasthenia, anamiia, 
chlorosis, hysteria, hypochondriasis, paralysis, and neuralgia of a con- 
stitutional origin, rheumatism and other toxic diseases, some forms of 
chorea, and oftentimes in functional disorders of the genital, digestive, 
and other special organs." 

In anosmia and chlorosis the usual remedies for these states may be 
much assisted by central galvanization, and localized applications to 
the vegetative organs. Regurgitation of food, gastralgia, and feeble- 
ness of digestion, are often signally benefited by galvanization of the 
pneumogastrics, and by localized applications to the abdominal organs. 
Strong currents are needed when internal organs are to be affected by 
electrodes applied to the integument of the abdomen. A more effec- 



ELECTRICITY. 427 

tive application in these cases consists in the use of an insulated rectal 
electrode, while a sponge electrode of large size, and well moistened, 
is passed over the various organs of the abdomen. The relief of con- 
stipation by this means has already been alluded to. 

Various diseases of the pelvic organs, both in the male and female, 
are successfully treated by electricity. Amenorrhea, when dependent 
on atony of the ovaries and uterus, is cured by static electricity, by 
faradism, or by an interrupted galvanic current. A shock from a 
Ley den- jar may be transmitted through the pelvis, or a strong faradic 
or galvanic current may be applied by means of one pole on the spine, 
the other on the hypogastric region. In the case of married women 
an insulated vaginal electrode may be introduced and placed in con- 
tact with the os uteri. This is a more effective way of making the 
applications than by the electrodes placed externally. In neuralgic 
dysmenorrhea the galvanic current will afford relief in a large propor- 
tion of cases ; and, in congestive dysmenorrhea, an inverse current 
will diminish the blood-supply, and thus lessen suffering. The treat- 
ment of these affections should be conducted during the interval. The 
chronic congestive enlargement of the uterus is sometimes remarkably 
benefited by a galvanic current of moderate intensity slowly inter- 
rupted, but it is doubtful if any case of chronic interstitial metritis is 
ever cured, or even ameliorated, by this means. 

Although the changes in the joints, induced by gout and rheu- 
matism, may not be cured by galvanization of the central nervous 
system, as claimed by Meyer, yet there is no doubt that myalgia, lum- 
bago, and other so-called rheumatic diseases of the muscular system, 
may be promptly relieved and cured by the constant current. The stiff- 
ness of the joints and the muscular soreness which remain after an at- 
tack of acute rheumatism are best relieved by passing a mild galvanic 
current through the affected parts. 

Herpes, especially herpes zoster, and prurigo, when they are refer- 
able to an alteration of the cutaneous nerves, are curable by electricity. 
The author has seen excellent results in cases of shingles, from gal- 
vanization of the affected intercostal nerves — the positive pole being 
placed over the point of emergence of the nerves, and the negative 
brushed over the terminal filaments in the skin. Beard reports the 
cure of obstinate cases of chronic eczema by central galvanization, and 
his results have been confirmed by others. The author has seen a 
number of cases of acne get well under the influence of galvanization 
of the cervical sympathetic, and local galvanization of the skin of the 
face — the positive pole on the neck, the negative passed over the af- 
fected parts. It need hardly be stated that strong currents are not to 
be used when the poles are applied in these situations. Among the 
other skin-affections treated by galvanism with success are prurigo, 
psoriasis, and even scleroderma ; but, as Dr. Piffard, of New York, 



428 EXCITO-MOTORS. 

has remarked, this method is "by no means uniformly successful." It 
is applicable to the treatment of the neuroses of the skin. 

Electrolysis. — When the electrical current is made to traverse 
insulated needles introduced into the tissues of the body, electrolytic 
effects are produced, decomposition of the tissues ensues, hydrogen 
and the alkalies appear at the negative pole, and acids and chlorine at 
the positive. Remak, in his various publications, much insisted on 
the catalytic action of the constant current. Effusions into and about 
inflamed parts, and into the substance of tumors, may be made to dis- 
appear by the external application of galvanism, through moistened 
sponge-electrodes. It is doubtful, however, whether neoplastic forma- 
tions can be thus made to undergo absorption. The disappearance of 
effusions induces such an appearance of shrinking of tumors and in- 
flammatory products, that actual absorption of the neoplastic material 
may be supposed to have occurred. 

Galvano-puncture is used to remove malignant and other new for- 
mations. The sanguine expectations once entertained that cancer can 
be thus removed, although justified by the results in a few apparently 
successful cases, have not been realized. Beard proposed and has 
executed a new method, entitled " working up the base," which con- 
sists in electrolytic decomposition of the subjacent parts of a can- 
cer. A number of needles, insulated to near their points, are intro- 
duced into the healthy tissues beneath the morbid growth, and a cur- 
rent from twenty to sixty elements is passed through them. Decom- 
position ensues, and there takes place a separation of the morbid 
mass. As the pain of this method is great, etherization should be 
resorted to. 

Aneurisms, so situated as to be beyond the reach of surgical inter- 
ference, have been treated by galvano-puncture, but the success, al- 
though brilliant in a few instances, has not been such as to justify 
very sanguine expectations of its future utility. Erectile tumors are 
curable by electrolysis. Goitre is sometimes made to disappear by 
the same means. The cysts connected with glandular tumors in the 
neck may be permanently occluded by galvano-puncture. The most 
useful applications of this method have been in hydrocele, which may 
be often cured in my experience by introducing two needle-electrodes, 
insulated to near their points, and passing a current from twenty to 
forty elements. - Not less effective is the same method in the treat- 
ment of hydatid disease of the liver. One needle connected with the 
negative pole is introduced, and the sponge-electrode is placed at some 
indifferent point on the abdomen. 

Spasmodic and permanent stricture of the urethra are treated by 
electrolysis, an insulated sound with a metallic tip, connected with the 
negative pole, being passed into the stricture, and the positive pole 
placed at some indifferent point. The most successful results have 



ELECTRICITY. 429 

been obtained by Mallez and Tripier, and Dr. Robert Newman, of 
New York ; but it is the author's observation, as also the expe- 
rience of Dr. Keyes, of New York, that this method has little real 
utility. 

Wounds and ulcers of an indolent character, and bed-sores, may be 
made to heal by attaching to them a galvanic couplet (zinc and silver), 
one of the elements remaining in contact with the sore, and the other 
on the skin in the neighborhood. They should be connected by a 
copper wire, and be confined to the parts by strips of adhesive plas- 
ter. This method has been especially serviceable in the treatment of 
bed-sores. 

Galvano-Cautery. — This method consists in cauterization by a 
platinum wire heated by the galvanic current. The battery used for 
this purpose furnishes a large quantity of electricity of low tension ; 
hence the elements are few in number but have extensive surface. 
When a quantity of electricity is made to traverse a platinum wire 
which offers great resistance, the wire is heated and may be melted. 
The platinum in the form of wire-loop, or dome cautery, or knife, 
heated by the electrical current, is the cauterizing agent. If the wire 
be not so highly heated as to cut through the tissues too rapidly, but 
little bleeding results, and a clean surface is left which promptly gran- 
ulates and heals. 

The instruments now employed for galvano-caustio work are chiefly 
the batteries of Piffard and Byrne, and the storage system of Trouve. 
Byrne's is said to be the most efficient of the original caustic batteries. 
The elements of this consist of zinc and platinum, and are so arranged 
as to offer the least resistance. The exciting fluid is bichromate solu- 
tion, and this is kept active by a bellows, or some other arrangement 
for agitating the fluid. 

The storage system is supplanting all other arrangements for the 
purposes of galvano-cautery. This consists of an element or combina- 
tion of elements which may be charged by another battery. The 
form of " storage-cell " or " accumulator " now chiefly used consists of 
plates of lead, immersed in dilute sulphuric acid. These are charged 
by some Daniell or Bunsen cells, communicating with them, and in 
action for several hours. Bubbles of hydrogen gas form on one lead 
plate, and of oxygen on the other ; whence they are said to be "polar- 
ized," and the current produced by the recombination of the gases is 
called a " current of polarization." By such an arrangement the quan- 
tity of electricity furnished by some Bunsen or other cells, acting for 
many hours or days, can be given out in a short time and in immense 
quantity. The accumulators of Faure, charged in Paris, have been 
transported across the ocean to give out their force in New York. 
Trouve has utilized this principle in constructing his " polyscope." A 
storage-cell of Plante is charged by the action of two Bunsen elements. 



430 EXCITO-MOTORS. 

and subsequently the stored-up electricity can be employed in heating 
a platinum wire or knife for cautery purposes, or for illumination. 

When this system is fully developed, storage-cells, or accumulators, 
will be provided from some station and transported to any point de- 
sired, and the force given out as required. Furnished with suitable 
platinum loops, knives, and cautery, the operator can employ the ma- 
chines anywhere. Obviously, this method will be utilized on a large 
scale for various operative procedures — for the removal of the tongue, 
of polypi, of haemorrhoids, for opening the trachea, deep-seated ab- 
scesses, etc. A beautiful application of the galvano-cautery was made 
by Thomas, when he opened the sac of a tubal pregnancy by a gal- 
vanic knife. The evident advantages of this system are the little 
pain which attends the operation, and the absence of haemorrhage. It 
is necessary to accurately adjust the strength of current, so that the 
wire or knife will have the requisite temperature to cut the tissues 
sufficiently and yet not so rapidly as to prevent adequate closure of 
the vessels. (For full details, see the author's " Treatise on Medical 
Electricity," second edition, p. 262, et seq.) 

Static Electricity. — The modified Holtz or Toepler-Holtz elec- 
trical machine is now used to procure all of the nerve and muscular 
effects hitherto obtained by faradic electricity, and also therapeutical 
results of a very striking kind. It has long been known that chorea 
and other nervous affections may be readily cured by static electricity, 
but a remarkable extension has been given to the subject by late dis- 
coveries. Chorea is now treated by the " electric bath," sparks being 
drawn from the spine. If the Holtz machine is used, sparks can readily 
be drawn through the clothing, by presenting the brass knob along 
the spine. The results, which have been so long obtained at Guy's 
Hospital by this mode of electrical applications, are now generally 
conceded. It seems to be the most successful method of treating this 
disease. Neuralgia is now promptly relieved in most instances by in- 
sulating the patient and drawing sparks from along the trajectory of 
the nerve affected. The pains of progressive locomotor ataxia are 
much benefited in the same way, and it is said the disease itself is 
arrested. Amenorrhea, other conditions favorable, is quickly cured 
by sparks, or a shock sent through the pelvis. The general nutrition 
is greatly promoted by electrization by sparks. 

The Toepler-Holtz machine may, by connecting the interior of one 
condenser with the exterior of the other, be utilized to procure the 
muscle and nerve reactions of the faradic current. 

TrouvVs Polyscope, referred to above, will probably be largely 
employed in the future, for the purposes of illumination. Suitable 
throat and other mirrors, platinum knives, and loops, are furnished 
with the instrument for illumination of the cavities, and for the va- 
rious caustic operations. It is very powerful, occupies but little space. 



NUX VOMICA. 431 

and promises, when certain mechanical defects are overcome, to fulfill 
more perfectly than any other apparatus the requirements of a surgi- 
cal galvano-caustic and a medical illuminating apparatus. 

Authorities referred to in this article : 

Allbutt, Dr. T. Clifford. The Electric Treatment of the Insane. The West Riding 
Lunatic Asylum Reports, vol. ii, p. 203. 

Althaus, Dr. Julius. A Treatise on Medical Electricity, second edition, Philadel- 
phia, 1870. 

Bartholow, Dr. Roberts. Medical Electricity. A Practical Treatise on the Applica- 
tions of Electricity, etc., Philadelphia, H. C. Lea's Son & Company, second edition, 1882. 

Beard and Rockwell. A Practical Treatise on the Medical and Surgical Uses of 
Electricity, New York, 1871. 

Benedikt, Dr. Moritz. Elektrotherapie, Wien, 1868. 

Duchenne, Dr. G. B. (of Boulogne). Be V Electrisation Localisee, Paris, 1861. 

Erb, Dr. Wilhelm. Handbuch der Elektrotherapie, Leipzig, 1882. 

Eulenburg, Dr. Albert. Lehrbuch der functionellen Nwvenkrarikheiten, Berlin, 1871, 
p. 78, et seq. 

Frommhold, Dr. Carl. Die Migraine und ihr Heilung durch Electricitdt, Pesth, 1868. 

Gordon, J. E. H. A Physical Treatise on Electricity and Magnetism. In two volumes, 
New York, 1880. D. Appleton & Co. 

Hammond, Dr. William A. A Treatise on Diseases of the Nervo2cs System, New York, 
1871. 

Hamilton, Dr. Allan McLane. Clinical Electro- Therapeutics, New York, 1873. 

Jaccoud, Dr. S. Trait'e de Pathologie Interne, vol. i, Paris, 1870. 

Morgan, Dr. Charles E. Electro-Physiology and Therapeutics, New York, 1868. 

Onimus, E., et Ch. Legros. Traite d' 'Electricite Medicale, Paris, 1872. 

Remak, Dr. Robert. Galvanotherapie, traduit de l'Allemand, Paris, 1860. 

Reynolds, Dr. J. Russell. Lectures on the Clinical Uses of Electricity, Philadelphia, 
1872. 

Strumpf, Dr. Centralblatt fur die Neurologische Med., Band i, No 1. 

Voltolini, Dr. Rudolph. Die Anwendung der Galvano-Kaustic, Wien, 1872. 

Ziemssen, Dr. Hugo von. Die Electricitdt in der Medicin, erste Halfte, Berlin, 1872. 

Nux-VomiCl. — The seeds of Strychnos nux-vomica Linne (Nat. Ord. 
Loganiacece). (IT. S. P.) Noix vomique, Fr. ; Krahenaugen, Ger. 

Abstractum Nucis Vomicce. — Abstract of nux-vomica. Dose, gr. 
ss— gr. ij. 

JExtractum Nucis Vomicce. — Extract of nux-vomica. Dose, -J — 

Extvactum Niicis Vomicce Fluidum. — Fluid extract of nux-vomica. 
Dose, Hi, j — in, v. 

Tinctura Nucis Vomicce. — Tincture of nux-vomica. Dose, ttj, j — 
■ni xv. 

Composition. — Nux-vomica contains two alkaloids and a peculiar 
acid. The alkaloids are strychnine and brucine, and the acid strychnic 
or igasuric acid. The proportion of strychnine ranges from one fourth 
to one half of one per cent, and of brucine from one eighth to one per 
cent. These wide differences are in great part due to the varying skill 
of the chemists who have made analyses. Besides these, another crys- 



432 EXCITO-MOTORS. 

tallizable base has been discovered in the mother-liquor from which 
strychnine and brucine have been precipitated. This has been named 
igasurine. The alkaloids exist in nux-vomica in combination with 
igasuric acid. 

Strychnine is a white or grayish- white powder, of an intensely 
bitter taste, nearly insoluble in water, slightly soluble in cold alcohol, 
and readily soluble in boiling alcohol. When heated it melts, and by 
strong heat is wholly dissipated. It is but slightly or not at all red- 
dened by nitric acid. A small j:>ortion dissolved in official sulphuric 
acid yields, on the addition of a minute quantity of bichromate of 
potassium, a splendid violet color. 

Strychnines Sulphas, — Sulphate of strychnine. A white salt, in 
colorless, prismatic crystals, which are without odor, exceedingly bit- 
ter, soluble in ten parts of water, sparingly soluble in alcohol, and in- 
soluble in ether. They effloresce on exposure to the air, and melt 
when heated, losing nearly fourteen per cent of their weight of water 
of crystallization. By a strong heat they are wholly volatilized. Dose, 

gr- eV— g r - iro- 

Antagonists and Incompatibles. — The paralyzers, such as woo- 
rara, conium, tobacco, opium, belladonna, and physostigma, antagonize 
the actions of strychnine in a part of the sphere of its influence. 
They do not antagonize its toxic action. Chloral, tobacco, bromide of 
potassium, ether, and chloroform (inhaled), are its true physiological 
antagonists. 

In cases of poisoning, tannin and the vegetables containing it 
should be freely administered, for the tannate of strychnine is very 
insoluble. Emetics, or the stomach-pump, must be used promptly. 
The tetanic spasms are best controlled by chloral and the inhalation 
of ether, or by tobacco, or by the bromide of potassium in very large 
doses ( 3 ij — 3 ss). The maintenance of artificial respiration has a 
decided effect in postponing in animals as in man the lethal action of 
strychnine. 

Strychnine should not be combined with bromides, chlorides, and 
iodides, in the same solution. Accidents have happened by taking the 
last portion, which will contain all of the strychnine, precipitated as 
hydrobromate, hydriodate, etc. 

Synergists. — Brucine, picrotoxine, thebaine, ergot, and, according 
to my own experimental investigations, belladonna, electricity, cold, 
etc., promote the activity of nux-vomica and its alkaloids. 

Physiological Effects. — The preparations of nux-vomica are ex- 
tremely and persistently bitter. Like all bitters, they promote the 
flow of the stomach and intestinal juices, increase the digestive power, 
and thus favorably affect the appetite. They also hasten the intestinal 
movements, and the stools voided are somewhat relaxed. 

The alkaloids of nux-vomica are very diffusible substances, and 



NUX VOMICA. 433 

enter the blood very quickly. They lessen somewhat the oxidizing 
power of the blood, but this effect .is quite insufficient to account for 
the physiological reactions produced in the nervous system. Small 
medicinal doses of nux-vomica and its alkaloid accomplish no more 
than other bitters, as respects the circulation. More or less plethora, 
slightly increased action of the heart, and, as a consequence of this 
condition of the vascular system, a greater energy in the performance 
of the various functions, result from their administration. 

When a lethal dose of nux-vomica, or of its alkaloid, has been 
taken, characteristic symptoms follow in a few minutes. The state 
of the stomach as to food, the presence of tannic acid in the food, and 
of fat, probably ; also the condition of the blood-vessels, influence the 
rate of absorption, and symptoms may begin in a few minutes or be 
delayed an hour or even longer. When a full medicinal dose has 
been taken, some slight shuddering, a sense of constriction of the 
fauces and jaws, sudden pains like electric shocks passing through the 
limbs, startings of some of the voluntary muscles, dilated pupils, " a 
meaningless smile," paleness of the face, followed by flushing and 
increased warmth of the surface and perspiration, are symptoms which 
may be produced without further development of a toxic action. If 
the dose be large enough to cause death, the above-described symptoms 
are quickly followed by tetanic convulsions, in which nearly all the 
voluntary muscles are engaged. When the paroxysm occurs, a shud- 
der passes through the whole frame ; the head and extremities jerk 
and twitch, and then suddenly a general tonic convulsion takes place 
— the limbs are extended, the hands clinched, the toes and feet incur- 
vated, the head bent backward, the body arched and rigid, the 
abdominal muscles hard and tense, the respiratory muscles fixed so 
that the body, curved in the form of a bow, rests on the occiput and 
heels. The countenance assumes a ghastly grin — the visits sardonicus ; 
the arrest of the respiratory movements suspends oxidation of the 
blood, and the skin becomes cyanosed ; strong erections of the penis 
occur, and frequently involuntary evacuations of semen, urine, and 
faeces take place. Rarely does death ensue in the first paroxysm ; 
the spasm relaxes, and nothing remains of the attack but the muscular 
soreness and fatigue, and the sense of impending dissolution. Ab- 
solute quiet retards the paroxysms. At first the senses are preternat- 
urally acute, and, as the reflex function is abnormally excitable, the 
slightest peripheral irritation suffices to bring on the spasms. Gener- 
ally patients experience comfort when the limbs are strongly held, or 
even rubbed, during the paroxysms ; but, in the interval, absolute 
quiet is most grateful. The mind remains unaffected until the close, 
or, at least, until carbonic-acid poisoning sets in. The paroxysms 
rapidly succeed each other, and increase in duration and severity, 
death occurring usually by fixation of the muscles of respiration, or 
29 



434 EXCITO-MOTORS. 

by exhaustion, and within two hours, as a rule, from the beginning of 
symptoms. 

The remarkable similarity in the symptomatology of traumatic 
tetanus and strychnine tetanus requires that the points of difference 
between them be clearly set forth. In strychnine tetanus the jaw- 
muscles are not first thrown into spasm, and are not always rigid dur- 
ing the paroxysm ; in traumatic tetanus, trismus is one of the first 
symptoms. In strychnine tetanus, after the convulsion, lasting from a 
half to one or two minutes, there is usually complete relaxation ; in 
traumatic tetanus rigidity of the affected muscles continues. A case 
of strychnine tetanus goes on rapidly increasing in severity, and lasts 
from a few minutes to two hours ; a case of traumatic tetanus proceeds 
more slowly, and lasts always a number of hours, and may extend over 
days and even weeks. And, lastly, in traumatic tetanus, the capital 
symptom of a wound or injury exists. 

No very characteristic post-mortem appearances result from strych- 
nine-poisoning. The muscles, at first relaxed, become rigid, the feet 
turned in, the fingers clinched, or the body may maintain the position 
of opisthotonos, in which it was at the moment of death. Conges- 
tion of the cerebral and spinal meninges is usually observed, and 
Schroeder Yan der Kolk first ascertained that dilatation of the vessels 
and sanguineous extravasations are found in the gray matter of the 
cord (medulla oblongata), and this observation has since been repeat- 
edly confirmed. 

The smallest quantity of strychnine which has produced a fatal re- 
sult in an adult was a half -grain. Rarely can one twelfth of a grain 
be given without causing muscular twitchings, and one sixteenth of 
a grain has caused death in a child of between two and three years. 

The effects of strychnine are exerted on the spinal cord, on the 
seat of the motor functions. It does not affect the functions of the 
motor nerves directly — the irritability of the motor nerves is not de- 
stroyed by strychnine, it is exhausted by over-stimulation. The sen- 
sory nerves are either unaffected, or their irritability is exhausted. 
The reflex functions of the spinal cord are exalted. The afferent 
nerves, while preserving their irritability, communicate impressions to 
the reflex centers, motor impulses are quickly originated, and the mus- 
cles through the motor nerves are fixed in a state of tonic contraction. 
The over-stimulation of the cord and the motor nerves exhausts the 
irritability of the latter. The muscles preserve their contractility. 

The effects of strychnine are not limited to the nervous system of 
animal life : the organic nervous system participates in the perturba- 
tion. The dilatation of the pupil, the erection of the hair-follicles, the 
tinnitus, the increased heat in the limbs, and the perspiration which 
are produced when strychnine is injected subcutaneously, indicate an 
influence on the sympathetic system similar in kind to that exerted 



NUX VOMICA. 435 

on the voluntary. Experimental investigations have confirmed these 
clinical observations. A very considerable rise in the arterial pressure, 
contraction of the vessels in the frog's web, and increased action of 
the heart, have been experimentally demonstrated to be caused by 
strychnine (Sigmund Mayer). 

Magendie, who made the first study of the actions of strychnine, 
found that, by previously destroying the spinal cord, no convulsions 
followed the administration of a poisonous dose. The precise agency 
of the cord is disputed, but it is in a high degree probable that the 
condition is one of exaggerated reflex excitability, so that the smallest 
possible peripheric irritation induces a response in the reflex motor 
center. When Setschenow's inhibiting center of reflex movements is 
withdrawn as in the decapitated frog, the spasms are induced as before. 
The passage over the face of the faintest current of air, even the men- 
tal conception of such an impression, will excite the spasms. Abso- 
lute repose, as by placing the poisoned frog under a bell-glass, the 
table firm so that no jar can reach the animal, and light excluded, has 
a decided effect in preventing attacks. If a poisoned human subject 
is similarly protected, the convulsions are diminished in violence. 
Again, if, when the convulsions are impending, the limbs are firmly 
grasped and held, the force of the spasm is lessened thereby. The 
medicines most effective in affording relief are those which lower the 
activity of the reflex function — notably chloral, bromide of potassium, 
etc. These facts indicate that an exaltation of the reflex function of 
the spinal cord is caused by strychnine. But this is probably not 
alone sufficient : irritation of the motor cells is also a factor (Spitzka). 
In opposition to the commonly accepted view, Falck maintains that 
strychnine acts primarily on the brain, or rather on the vaso-motor 
center of the brain, then on the inhibitory center for the heart, and the 
respiratory center, and lastly on the reflex apparatus of the cord. The 
spasms are the combined results of these actions. 

Bernard held that the sensibility of the sensory nerves is destroyed 
by strychnine, but after the motor functions have ceased. Martin- 
Magron, and subsequently Yulpian, ascertained that the sensibility 
persists after motility has ceased. This contradiction of supposed 
facts has been examined more recently by Busch, whose observations, 
if entitled to belief, support the statement of Bernard. Busch has 
found that the toe of the poisoned frog may be crushed, and the cen- 
tral portion of the divided sciatic may be burned, without inducing 
spasms or reflex movements, when the slightest jar of the animal will 
cause strong convulsions. Kolliker and Vulpian, with many others, 
hold that the excitability of the motor nerves is so far impaired by 
strychnine that irritation of the nerve-trunk produces very feeble or 
no muscular contractions, The American observers Klapp and Spitzka 
both maintain that the peripheral nerves are unaffected in strychnine- 



43G EXCITO-MOTORS. 

poisoning. Martin -Magron et Buisson and Vulpian find that the action 
of strychnine is local on the nerves, and is therefore greatly influenced 
by the quantity of the poison reaching them. If the dose of strych- 
nine is small, the motor and sensory nerves remain unimpaired ; but if 
the dose be large, their irritability is destroyed. The influence of the 
quantity administered is consequently very great, and is exhibited in 
other respects. Thus, while a merely lethal dose causes strong con- 
vulsions, a very large toxic dose will kill at once without any reflex 
disturbances. It is impossible, then, to make the distinction between 
motor and sensory nerves as respects the action of strychnine: it either 
destroys or spares the excitability of both. 

While strychnine exalts the irritability of the reflex motor center, 
it stimulates the vaso-motor center or centers in the cord, with the re- 
sult of greatly increasing the blood-pressure. This rise in blood-press- 
ure is prevented by dividing the cord, according to Mayer, Klapp, 
and others, but, according to Schlesinger, not. Now, as it has been 
found by Richter, who has studied the circulation in transparent parts, 
by Mayer, and by Spitzka, that the arterioles strongly contract under 
the influence of strychnine, the blood-pressure must rise from this 
cause ; hence, the observation of Schlesinger is probably correct, that 
the blood-pressure rises in strychnine-poisoning, notwithstanding di- 
vision of the cord. As has been tersely expressed by Spitzka, " its 
vaso-motor effect is to increase the blood-pressure and the rapidity of 
the blood-current by contracting the arterioles. This effect is inde- 
pendent of the central nervous system." The effects of strychnine on 
the heart differ in cold- and warm-blooded animals, according to most 
authorities, and decidedly, also, according to the size of the dose. On 
frogs, the diastolic pause is prolonged, and the force of the systole 
augmented, so that arrest of the heart's action may take place in te- 
tanic rigidity. These results, Spitzka holds, are due to an action on 
the cardiac ganglia and on the pneumogastric. The previous obser- 
vations of Heinemann, however, do not correspond, for he finds that 
these phenomena are produced after the vagi are divided. In warm- 
blooded animals the heart's action is accelerated, while the tension is 
raised. Klapp, however, finds that strychnine slows the pulse in the 
cat and rabbit, and that the retardation is due to an impression on the 
cardiac motor ganglia, and not to stimulation of the inhibition. He 
finds that the action is the same on both classes of animals. These 
contradictions are probably due to the difference in the dose employed. 
A large toxic dose of strychnine will paralyze, instead of stimulate, 
the vaso-motor center in the medulla, and thus prevent any rise of 
blood-pressure. A small, merely lethal dose will stimulate the cardiac 
ganglia, the pneumogastric, and the vaso-motor ganglia ; but a large 
toxic dose will slow the heart, paralyze the vagi and the accelerator 
apparatus, and depress the vaso-motor functions generally. In the 



NUX VOMICA. 437 

course of annual experiments for class instruction, the author has con- 
stantly observed the difference in results due to the quantity adminis- 
tered. 

From clinical observation, in the absence of any experimental evi- 
dence, strychnine has been ascertained to have a stimulating effect on 
the respiration. If the dose is less than sufficient to tetanize, the func- 
tion of respiration is increased in energy and in depth. Hence, this 
agent antagonizes the respiratory poisons, as well as those morbid 
states which depress the respiratory function. 

On the blood, the experiments of Harley show, strychnine has some 
action. Agitation of blood with the air, in the presence of strychnine, 
is followed by a less production of carbonic acid than if strychnine be 
not present, but such experiments are entitled to small consideration. 
Strychnine, as Hippel and Cohn have shown, stimulates the retina and 
increases the sharpness of definition and the area of the visual field. 
These facts explain the curative effects of strychnine in certain dis- 
eases of the retina. 

Very peculiar phenomena have been observed by Spitzka as a re- 
sult of chronic poisoning — an entirely new subject. It appears to be 
exceedingly difficult to keep animals alive, but Spitzka succeeded in 
maintaining five frogs in tetanus for over forty days. Symptoms oc- 
cur under these circumstances quite distinct from those produced in 
acute poisoning by strychnine. Disease in the cord is set up, " partly 
as an insular sclerosis, partly as an hemorrhagic or non-hgemorrhagic 
myelitis." These experiments demonstrate that, to maintain a con- 
stant effect by strychnine in the beginning, the dose must be increased, 
but later the quantity given may be decreased and administered at 
longer intervals. The importance of these observations from the ther- 
apeutical point of view is, indeed, great. The symptoms occurring 
from chronic poisoning are, as respects the spasms, a diminution of 
their energy, the development of an ataxic state, with tremors and 
pupillary myosis. These phenomena approach those produced by pi- 
crotoxin, and are intermediate between the effects of strychnine proper 
and of curara or methyl strychnium. 

Therapy. — The tincture of nux-vomica is one of the numerous 
remedies proposed for the vomiting of pregnancy. It is best adapted, 
according to the author's observation, to those women who have a sea- 
sick feeling and who do not vomit much. Half a drop to a drop, 
in cherry-laurel water, or in simple water, every hour or two, is a 
suitable dose. Like all other remedies, nux-vomica often fails in this 
malady. Owing partly to its intense bitterness, and partly to its in- 
fluence on the nervous system, the tincture of nux-vomica is an excel- 
lent stomachic tonic, adapted more especially to the treatment of those 
cases in which there is a neurotic element, as, for example, atonic dys- 
pepsia and gastralgia. From five to ten drops three times a day be- 



438 EXCITO-MOTORS. 

fore meals is a suitable dose in these cases. In chronic gastric catarrh, 
whether occurring as an independent affection, or as an accompani- 
ment of other maladies, the tincture of nux-vomica is one of the most 
effective bitters. In the gastric catarrh and morning vomiting of 
drunkards, this remedy is next in value to arsenic. It may be given, 
advantageously, with mineral acids. The poor appetite, the feeble 
digestion, and the nervousness and trembling, which follow the sudden 
withdrawal of alcoholic stimulants, may be removed by frequent small 
doses of the tincture. To diminish the craving for stimulants when 
they are withdrawn, and to sustain the nervous system, the following 
combination is exceedingly effective : ^ Tinct. capsici, 3 vj ; tinct. 
nucis vom., 3 ij. M. Sig. : Twenty drops in water every four hours. 
Intestinal indigestion and flatulence are also removed by tincture of 
nux-vomica. 

In atonic diarrhoea, nux-vomica is a serviceable addition to other 
remedies, when a paretic condition of the muscular layer of the bowel 
may be presumed to exist. It is, however, more especially in consti- 
pation that nux-vomica is useful. It is indicated in those cases in 
which there are inaction of the muscular layer and, consequently, great 
fecal accumulations. It may be most advantageously given with pur- 
gatives in such cases : $ Tinct. aloes et ruyrrhae, 3 vj ; tinct. nucis 
vomicae, 3 ij. M. Sig. : Fifteen to thirty drops two or three times a 
day. 

Nux-vomica has been signally useful in some forms of epidemic 
dysentery. It is indicated when there is depression of the vital forces, 
the intestines distended with gas, the stools like prune-juice. In some 
epidemics of cholera, strychnine, combined with mineral acids and 
opium, has appeared to be effective when the patient was about to pass 
into the state of .collapse ; and it has also been used as a prophylactic 
during the preliminary diarrhoea : fy Strychninae sulphat., gr. J ; acid, 
sulphuric, dil., § ss ; morphinae sulphat., gr. ij ; aqua? camphoras, f iijss. 
M. Sig. : A teaspoonful every hour or two, well diluted. This combi- 
nation is also effective in summer diarrhoea, when the evacuations are 
very watery, and in colliquative diarrhoea. When there is much pain, 
the quantity of morphine may be increased, or the first dose may be 
doubled. When the character of the case is such as to require con- 
tinued use of the prescription, of course, the quantum of strychnine 
must be lessened. 

Nux-vomica and its alkaloid strychnine are much used in combi- 
nation with restorative remedies, in cases of impoverished blood — in 
ancemia, chlorosis, haimorrhagic diathesis, purpura, etc. In anaemia 
and chlorosis strychnine is used with reference to its power to stimu- 
late the blood-making organs, which functionate under some special 
influence proceeding from the nervous system. r> Ferri sulph. exsic, 
3ij ; quininae sulph., 3j ; strychninae sulph., gr. ss. M. Ft. pil. no. 



NUX VOMICA. 439 

xx. Sig. : One pill three times a day. No prescription is more gen- 
erally useful in these states than the sirup or elixir of iron, quinine, and 
strychnine, a formula originally proposed by Aitken. 

In the treatment of amenorrhea, the preparations of nux-vomica 
and strychnine frequently enter into the composition of prescriptions. In 
post-partum haemorrhage, Fordyce Barker prescribes the tincture of 
nux-vomica (twenty drops), and fluid extract of ergot (thirty drops), 
" every half -hour until well assured that the uterus is well contracted." 
It is obvious that not more " than two or three doses " of such strength 
will be safe. The neuralgic form of dysmenorrhcea may be permanently 
removed by nux-vomica given during the interval. 

When impotence is due to mere relaxation and atony of the erectile 
apparatus, and is not dependent on organic defects, the preparations of 
nux-vomica are indicated and are useful. Incontinence of urine, when 
due to a paralytic state of the sphincter, may sometimes be cured by 
strychnine. Nocturnal incontinence, which is most successfully treated 
by belladonna, ergot, and iodide of iron, is sometimes not relieved by 
these agents, when strychnine may be tried. The author can not state 
with precision the cases in which it succeeds, but it has appeared to 
him most successful in those cases dependent on simple atony of the 
bladder, associated with general laxity of fiber. 

The most important uses of nux-vomica and its alkaloid are in the 
treatment of nervous affections, chiefly in paralysis. It may be used 
with advantage in hemiplegia, when sufficient time has elapsed to per- 
mit repair of the damage done by the extravasation. It is improper to 
use strychnine during the period of " early rigidity," and it is without 
avail in cases of " late rigidity " of the paralyzed members. It is most 
useful when the paralyzed members are completely relaxed. It is use- 
less when the paralysis has existed so long that the muscles have under- 
gone fatty degeneration, so that they no longer respond to a faradic or 
slowly-interrupted galvanic current. Even if the necessary conditions 
as respects the state of the muscles are present, strychnine is inadmis- 
sible in cases of paralysis of cerebral origin when there are vertigo, 
headache, and tinnitus. 

In paraplegia of reflex origin, in rheumatismal paraplegia, in syphi- 
loma of the spinal meninges, paraplegia continuing after the removal 
of the deposits, strychnine is a most serviceable remedy. 

The best results are obtained from the use of strychnine in local 
paralysis, in lead-colic and constipation, and in drop-iorist, in mercu- 
rial and pahtdal palsies, in rheumatismal paralyses — for example, fa- 
cial paralysis, from exposure of the face to cold — torticollis, spinal 
curvature, from paresis of the muscles on one side, etc. 

In certain forms of spasms strychnine sometimes achieves most im- 
portant results. The evidence which has been accumulated as to the 
curative power of strychnine in tetanus would be very conclusive if 



4-40 EXCITO-MOTORS. 

it were worthy of credence, which seems to the author doubtful. In 
this disease it should be given so as to substitute the strychnic for the 
traumatic tetanus, but the symptoms induced should not exceed those 
due to a full medicinal dose. Strychnine is most successful — as indeed 
are all the appropriate remedies — in the more chronic cases of tetanus, 
and in those of spontaneous rather than traumatic origin. 

Trousseau's experience is strongly in favor of the use of strychnine 
in the treatment of chorea. The method which he has pursued does 
not commend itself — it is heroic, and indeed unsafe. It consists in the 
use of such doses, beginning with one dose a day and increasing them, 
until stiffness of the muscles of the neck, spasmodic jerkings, and a 
" meaningless smile," indicate the beginning of strychnic poisoning. 

Strychnine is a very serviceable remedy in idiop>athic or essential 
epilepsy. It is adapted to pale, anaemic young subjects who have the 
petit mal, as well as the grand mal, and whose attacks are nocturnal. 
It exerts no influence but an injurious one over symptomatic epilepsy — 
that dependent on " coarse organic lesions of the brain." It is said 
that the state of the retinal circulation furnishes an indication for 
strychnine or bromide of potassium, fullness of the retinal vessels be- 
ing an indication for the latter agent, and pallor and anaemia for the 
former. 

In that functional irritability of the nervous system manifested by 
restlessness and wandering neuralgic pains, strychnine affords relief. 

Spasmodic asthma of nervous subjects, when the paroxysms are 
due to an irritable state of the nervous system, are associated with 
vague neuralgic pains, and are determined by psychical influences, may 
be so far influenced by the persistent use of strychnine as to occur 
much less frequently. 

Amaurosis of a functional kind, from lead, tobacco, and alcohol, 
may be cured by strychnine. Paralysis of the ocular muscles (proso- 
palgia), of the muscle of accommodation, and paralysis of a single 
muscle, when these affections are due to an arrest of function of the 
nerve or nerves, and do not involve changes of structure, are curable 
by strychnine. Nagel, however, reports a cure of amaurosis in which 
there existed white atrophy of the optic disks ! 

Holtenhof points out the kind of amblyopia most benefited by this 
treatment. The cases without serious lesion, those dependent on anae- 
mia, on a reflex effect from some part of the trigeminus or sympa- 
thetic, or due to the abuse of tobacco and alcohol, are especially 
amenable to the strychnic treatment. "In central amblyopia," says 
Holtenhof, " without lesion of the macula and with decoloration of the 
temporal portion of the optic disk, I have obtained remarkable im- 
provement by the use of strychnine." Again, when there are lesions 
resulting from the deep-seated inflammation of the membranes, im- 
provement may be hoped for when the primary inflammation has 



NUX VOMICA. 441 

ceased and the consecutive atrophy is stationary. In retinitis pigmen- 
tosa the results produced by strichnine are very striking. In five cases 
the diurnal dimness of vision and the nocturnal blindness were relieved 
considerably, in four cases there ensued an augmentation in the acuity 
of vision, and in two the visual field for white light was enlarged. 
Holtenhof finds strychnine inferior to electricity in the treatment of pa- 
ralysis of the ocular muscles. 

Strychnine has remarkable powers as a respiratory stimulant. Since 
the introduction of Aitken's formula for the phosphate of iron, qui- 
nine, and strychnine, the fact of its utility in chronic bronchitis, in- 
cipient phthisis, dilated bronchi, etc., has been distinctly recognized. 
The good effects of this combination are due chiefly to the strychnine. 
We possess no remedy more generally effective in the vomiting of 
phthisis than strychnine. This vomiting is reflex mainly, and occurs 
at the termination of a paroxysm of coughing, but there is also more 
or less stomachal indigestion. As the stomach is emptied, the vomiting 
interferes with nutrition. Strychnine has also, as Murrell has shown, 
some power to lessen the sweating of phthisis. This agent may, there- 
fore, be regarded as an important remedy in consumption. There are 
several modes of administration, but the best is by solution, the alka- 
loid dissolved in water with a mineral acid : fy Strychnine, gr. j ; 
acid, muriatic, dil., g j. M. Sig. : Five to ten drops in water three 
times a day. 

Strychnine is one of the antidotes to chloral, as was first shown by 
Liebreich, but it is not the chief. It may be utilized cautiously as one 
of the means of counteracting the respiratory and cardiac depression, 
but it should not be depended on wholly. 

Nux-vomica has been used with success in the treatment of inter- 
mittents. At present it is rather employed as an adjuvant to quinine, 
than relied on as the sole curative agent. 

Hypodermatic Injection of Strychnine. — This important thera- 
peutical measure needs to be separately discussed. The solution which 
the author advises is as follows : 3 Strychnine sulphat., gr. j ; aquae 
destil. vel aquae lauro-cerasi, § j. M. Sig. : Ten minims contain one- 
forty -eighth of a grain. Some heat is usually necessary to procure 
a perfect solution. 

" The effects of strychnine," as has been well remarked (Echeverria), 
" are widely different when administered hypodermically or by the 
mouth. By the latter method the quantity may be repeated and in- 
creased, unsuccessfully, . . . and yet a smaller dose of the substance, 
exhibited hypodermically, be capable of regenerating at once the lost 
muscular power." 

The indications for the subcutaneous use of strychnine are precisely 
as those given above for its stomach administration : it is contraindi- 
cated in cases of hemiplegia when the injury to the brain has been 



442 EXCITO-MOTORS. 

recent. It generally does no good, but harm, when the paralyzed 
muscles are rigid. It is most useful in old cases of hemiplegia, the 
subjects not being advanced in life, the paralysis incomplete, the 
muscles flaccid but not wasted, and having preserved their electro- 
contractility. Very remarkable improvement not unfrequently fol- 
lows from this mode of treatment in suitable cases. 

The hypodermatic injection of strychnine sometimes is entirely 
successful in curing paraplegia, but the limits of its utility are well 
defined. It is not proper, and is in every way injurious, in acute 
cases involving structural alterations of the spinal cord. In doubtful 
cases, a strychnine injection may be used as a means of diagnosis be- 
tween structural and functional diseases of the cord : in the former, 
the symptoms are increased in definition ; in the latter, they are ame- 
liorated by the injection. This mode of using strychnine is curative 
in reflex paraplegia, in paraplegia due to anaemia of the cord, in hys- 
terical paraplegia, and in those cases of paresis of the muscles of the 
inferior extremities due to concussion of the cord, to rheumatism of 
the meninges, and to syphiloma, after the local morbid process has 
ceased. 

In infantile paralysis, the hypodermatic injection of strychnine is 
an important addition to other means of treatment. If the electro- 
contractility of the affected muscles is not lost, very beneficial results 
may be expected : the injection promotes the capillary circulation, 
and increases the growth and power of the muscles. 

In no form of paralysis is the use of strychnine more conspicuous 
for good than in diphtheritic paralysis. Few cases are not promptly 
benefited and most are quickly cured. The utility of the subcutaneous 
injection of strychnine has been most signally exhibited in the loccd 
paralyses ; e. g., facial paralysis, aphonia from paralysis of the vo- 
cal cords ; paralysis of the extensors by lead ; paralysis of the sphinc- 
ter vesicw, of the sphincter ani, etc. 

The mode of practicing the injection is of considerable importance. 
The solution should be thrown into the substance of the paralyzed 
muscles. For example, in hemiplegia, the muscles in turn, of the 
paralyzed side, should be pierced by the needle, and the solution dis- 
charged into them. In drop-wrist the extensors should be grasped, 
made tense, and the needle of the syringe be thrust well into them. In 
paralysis of the sphincter ani and prolapse of the bowel, the muscle 
affected should be penetrated by the needle. When the affected mus- 
cles are beyond reach, the injection may be practiced at any indifferent 
point. 

Next to the treatment of paralyses, the most frequent application 
of strychnine by the hypodermatic method is in certain ocular mala- 
dies. In the normal condition, strychnine affects the visual functions. 
Hippel first studied these effects, afterward Sandi and Cohn, and sub- 



NUX VOMICA. 443 

seqnently, in France, Coumetou and Rouire. According to Counietou, 
strychnine augments the excitability of the retinal elements, increas- 
ing the sharpness of vision, central and peripheral, and also enlarging 
the visual field. He advises its use in amblyopia without lesions, de- 
pendent on functional disorder of the retina, and says it may also, if 
the lesions are not too far advanced, effect favorable changes in 
chronic diseases of the optic nerve and retina. Rouire also agrees 
with previous observers in stating that strychnine affects the optic 
nerve-fibers, increasing the normal acuity of vision and enlarging the 
visual field. He advocates its use in tabetic atrophy, and calls atten- 
tion to the fact that in certain atrophies good results are obtained 
only by a progressive increase in the amount administered. In these 
ocular maladies the solution may be injected in the temple, or in the 
nape of the neck, taking the usual precautions against accident. 

In infra-orbital neuralgia, good results have been obtained from 
the subcutaneous injection of strychnine. This practice may be very 
useful in neuralgia characterized by anaemia and depression. It may 
also be highly serviceable in epilepsy, the cases selected according to 
the rules already defined. 

Authorities referred to : 

Bernard, Cl. Legons sur les Effets des Substances Toxiques et Medicamenteuses, Paris, 
1857. 

Brunton, Dr. T. L. St. Bartholomevi 's Hospital Reports, vols, xii and xv. 

Busch, Dr. Berliner klin. Wochenschrift, No. 37, 1874. 

Coumetou, Dr. lliese de Paris. Strychnia dans la Chirurgie Oculaire. 

Delioux de Savignac, Dr. Bull. General de Therap., 1871, January, February, and 
March. 

Echeverria, Dr M. Gonz. Treatment of Paralysis by the Hypodermic Injection of 
Strychnine. Connecticut Med. Society, Trans, for 1868. 

Eulenburg, Dr. Albert. Lehrbuch der functionellen Nervenkrankheiten,Berlin, 1871, 
p. 450. Also, Hypodermatische Injcctionen. 

Falck, F. A. Archiv fur experimented Pathologie und Pharmacologic, Band iii, p. 77. 

Freusberg, A. Ibid., Band iii, p. 204 u. 308. Ueber die Wirkung des Strychnins 
und Bermerkungen uber die reflectorische Erregung der Nervencentrcn. 

Gorochofzeff, N. Deutsche Klinik, xl, 1874, p. 316. Versuche mit Strychnin. 

Holtenhof, Dr. Lyon Medicate. Quoted by Annuaire de Therapeutique, 1877, p. 
55, et scq. 

Haughton, Dr. Samuel. TIic British Medical Journal, June 22, 1872, p. 660. Poi- 
soning by Strychnine treated by Nicotine. 

Heinemann, Dr. Carl. Virchoufs Archiv, vol. xxxiii, p. 394. 

Hunter, Mr. Charles. Pamphlet containing reprints of various papers on Hypoder- 
mic Injections. 

Jochelsohn, Dr. On the Influence of Artificial Respiration over Poisoning by Strych- 
nine. London Medical Record, vol. i, p. 82. 

Klapp, Dr. W. H. The Journal of Nervous and Mental Diseases, vol. v, 1878, p. 619. 

Leube, Dr. William. Archiv fur Anat. und Physiologie, 1867, p. 629. 

Kolliker, Prof. Dr. Virchovfs Archiv, Band x, p. 239. 

Mayer, Dr. S. Archiv fur experimentelle Pathologie und Pharmacologic, Band ii, p. 458, 

Nagel, Prof. Dr. Berliner klinische Wochenschrift, vol. viii, p. 6, 1861. 



444 EXCITO-MOTORS. 

Schlesinger, Dr. London Medical Record, vol. ii, p. 35. 

Spitzka, Dr. E. C. Journal of Nervous and Mental Diseases, vol. vi, 1879. 

VutPiAN, Dr. Archives de Physiologie, Normale et Pathologique, 1870, p. 116, et seq. 

Ignatia. — Ignatia. The seed of Strychnos Ignatii Bergius (Nat. 
Ord. Zoganiacece). (IT. S. P.) St. Ignatius's bean ; Feve de Saint- 
Ignace, Fr. ; Ignazbohnen, Ger. 

Abstraction Ignatice. — Abstract of ignatia. Dose, gr. J — gr. j. 

Tinctura Ignatice. — Tincture of ignatia (10 parts of ignatia to 100 
parts of menstruum). Dose, tti ij — v\ x. 

Composition. — Ignatia Las the same composition as nux-vomica, 
but yields relatively larger proportions of the alkaloids strychnine and 
brucine. These principles exist in the bean in combination with iga- 
suric acid Formerly, the bean of St. Ignatius was the principal 
source of commercial strychnine, but the abundance and low price of 
nux-vomica now compensate for the difference in strength. The 
preparations of ignatia are stronger than the corresponding ones of 
nux-vomica. 

Antagonists, Incompatibles, and Synergists are the same as for 
nux-vomica. 

Actions and Uses. — Ignatia, containing the same principles as 
nux-vomica, must have the same physiological actions and correspond- 
ing therapeutical properties. 

The tincture of ignatia, the most useful preparation, has a power- 
ful and persistent bitter taste, and, in common with bitters, has the 
effect known as stomachic tonic. It is a very effective stimulant of 
the gastric mucous membrane, promotes the flow of gastric juice, and 
hence increases the activity of the stomach digestion, and may there- 
fore be used with advantage in atonic dyspepsia, and in the nausea 
and vomiting of gastric and cerebral ana?mia. It is also often highly 
serviceable in the gastralgia of nervous women having impoverished 
blood. The migraine or sick-headache of such subjects, also, may be 
relieved by ignatia. It may be very useful in the various disturbances 
belonging to chronic gastric catarrh, but it is contraindicated in all 
acute inflammatory affections. It is in these stomachal affections 
more especially that ignatia is preferred to nux-vomica by many prac- 
titioners. 

Ignatia affects the nervous system of animal life in the same way, 
but more energetically in the same dose, that nux-vomica does. It 
exalts in the same way the reflex function of the spinal cord, and simi- 
larly arrests respiration by a tetanic fixation of the respiratory mus- 
cles. It is, however, not used in affections of the nervous system, the 
alkaloid strychnine being now universally employed. 

Cocculus. — The fruit of Anamirta cocculus, or Coccidus Indicus. 
(Not official.) 



COCCULUS. 445 

There are no official preparations except picrotoxin, the active prin- 
ciple. A saturated tincture may be used. Dose, ttl ij — tu, xv. A 
fluid extract can be made, and is a useful form for administration. 
Dose, fi[ ij to tt], x, gradually increased. 

Composition. — The effects of cocculus are due chiefly to the presence 
in it of a peculiar neutral principle known as picrotoxin. This has been 
admitted to the Pharmacopoeia of 1880, and is therefore official. 

Picrotoxinum. — Picrotoxin, is not an alkaloid, although allied to 
this group of substances. It does not combine with acids to form salts. 
It is neutral, crystallizable, forming needle-shaped, stellar, or foliaceous 
crystals. It is soluble in 150 parts of cold and 25 parts of warm water, 
and in alcohol, and dissolves freely in alkaline solutions. It is unaffected 
in solution by the metallic salts, tannin, etc., and is not precipitated by 
the tests for the alkaloids. It may be administered in pill-form, and 
can be combined with any of the usual so-called nervine tonics. Pi- 
crotoxin may be administered subcutaneously, in solution in water — 
one grain to § ss — the dose ranging from -^ of a grain to ■£$ of a 
grain. By the stomach it may be given in from ^ of a grain to -^g-. 

Antagonists. — The carefully - conducted researches of Browne 
show that chloral is its physiological antagonist in rabbits and Guinea- 
pigs, and probably will prove to be of value in cases of poisoning in 
man. The anaesthetics, and the motor depressants in general, are an- 
tagonistic in respect to its power to produce spasm. 

Synergists. — All the remedies of this group, notably strychnine, 
brucine, and ergot, increase the effects of picrotoxin. 

Physiological Actions. — The taste of picrotoxin is bitter. It 
increases the flow of saliva. In what form soever administered, more 
or less nausea is produced, when the quantity given is sufficient to 
cause cerebral effects. It is not an irritant to the gastro-intestinal 
mucous membrane ; it increases secretion, and promotes peristalsis, 
but no hyperaemia of the mucous membrane has been observed after 
death from a toxic dose. The secretions of the glandular appendages 
of the mucous membrane, probably also of the pancreas and liver, are 
decidedly increased, the stools becoming soft and more copious. Ad- 
ministered at any point, picrotoxin diffuses readily into the blood, 
but nothing is known at present of the changes which it induces, if 
any, in the composition of the blood. After death the right side of 
the heart is distended, and the left side incompletely emptied and 
flaccid. The action of the heart varies with the stage of the effects, 
and doubtless also more or less according to the size of the dose. At 
first the cardiac movements are slowed, the arterial tension somewhat 
elevated ; during the convulsions the action grows rapid, but, succeeding 
the convulsions, and during the stage of coma, the pulse becomes slow 
again. According to Planat, by small doses, the cardiac pulsations are 
slowed before the convulsions come on ; then the muscular excitement 



446 EXCITO-MOTORS. 

induces rapid action, to be succeeded again by the retarding effects of 
the remedy, increased by the coma. Roeber also finds that the cardiac 
contractions are retarded, and the walls of the heart dilated and flac- 
cid. The respiration is also accelerated, and there occurs strong in- 
spiratory dilatation, because of spasm of the glottis — effects which are 
due to stimulation of the pulmonary portion of the vagus, and which 
cease on division of this nerve (Roeber). When the convulsions cease, 
the respiration becomes slower and more shallow. No engorgement of 
the lungs is found after death (Browne). 

The pupils are not specifically affected. During the convulsions 
they dilate somewhat, when the tonic spasms come on, and contract 
again during the clonic spasms. The fundus of the eye, examined by 
the ophthalmoscope, exhibits considerable hyperemia. 

The cerebral effects of picrotoxin are variously interpreted. Drow- 
siness, stupor, some muscular trembling, are observed in cold- and 
warm-blooded animals, and have also been experienced in man. A 
heavy, stupid intoxication, with vertigo, inco-ordination, and dimin- 
ished sensibility, followed by after-headache, depression, and nausea, 
are symptoms ascribed to the action of cocculus Indicus in beer so- 
phisticated by this drug. Restlessness, unsteady gait, and weakness of 
the hind extremities, also precede the convulsions in animals. Twitch- 
ing of the ears, shaking of the head, and spasms in the eyelids, eye- 
brows, lips, and fore-paws, now come on. Then follows a distinct 
tonic convulsive stage, with opisthotonos, or emprosthotonos, tetanic 
fixation of the muscles of respiration, cyanosis, and stertor. This 
tetanic stage is succeeded by the general clonic convulsions, and the 
seizure is terminated by a temporary paralysis and coma. In the order 
and succession and character of phenomena, a remarkable similarity in 
the actions of picrotoxin to the epileptic paroxysm must be discerned. 
By Roeber the convulsions are referred to the effects of the poison on 
the medulla. He finds that, after destruction of the brain, the symp- 
toms are the same as before ; after destruction of the optic lobes, the 
convulsions are less violent ; but when the medulla is removed the con- 
vulsions do not occur, and a large dose causes coma only. These facts 
indicate that picrotoxin acts on the spasm and vagus centers in the 
medulla, and on Setschenow's inhibitory center. Planat, Chirone, 
and Testa, also hold that this agent acts on the cerebellum, medulla, 
and spinal cord, and leaves the brain exempt. Against these opinions 
we have the carefully-considered but still hypothetical view of Browne, 
who finds in Ferrier's cortical centers the real seat of the action of 
picrotoxin. That the center, and not the periphery, is the place 
where the action of the poison is expended, seems proved by the 
studies of Roeber, who finds that the electrical reactions of nerve and 
muscle remain unaltered. 

The action of the heart is arrested in the diastole, and, while the 



COCCULUS. 447 

cavities are full, the capillaries at the periphery are empty. The vas- 
cular lesions, post mortem, are similar to those of epilepsy. That some 
of the poison is yet in the blood, is proved by the fact that flies eating 
it are poisoned. Elimination probably takes place by the various chan- 
nels of excretion, but chiefly by the kidneys. The skin is powerfully 
acted on, and hence picrotoxin ranks among the most active diapho- 
retics. The urinary excretion is also increased, but more exact obser- 
vations are needed on these points. 

Therapy. — Picrotoxin will, probably, be found very useful in 
cases of torpor of the intestines, dependent on deficient secretion and 
paresis of the muscular layer. In the night-sweats of consumption it 
has been used with great success by Murrell, who had but one failure 
in twenty cases. He finds that it is best to give the necessary dose at 
night — from y^ grain to -g^. The effect lasts about ten days, when 
the sweating begins again, and the remedy must be repeated. Picro- 
toxin has been used with success in the treatment of epilepsy by Pla- 
nat, Dujardin-Beaumetz, Hurd, and by Hammond. It is more espe- 
cially adapted to the weak and anaemic type. It has been also used 
with success in chorea, and with promising results in paralysis agitans. 
In a case of glosso-labio-laryngeal paralysis Gubler obtained a notable 
amelioration. Further experiences with these diseases are much need- 
ed. It is probable that this remedy may be applied with advantage 
to the treatment of other paralyses. According to Tsehudi, it has 
been given in paralysis of the sphincters with good results. The 
tremors of chronic alcoholism have, it is said, been removed by it. 
One of the forms of sick-headache — that occurring at or about the 
menstrual period — is sometimes greatly relieved by its timely exhibi- 
tion. An ointment of picrotoxin — ten grains to an ounce of simple 
ointment — has been applied with success to the treatment of para- 
sitic skin-affections. Care is necessary, and abraded surfaces must be 
avoided. 

A saturated tincture of cocculus Indicus might be employed in place 
of picrotoxin. Planat recommends a tincture composed of one part 
of the berries to four parts of alcohol, and of this one drop is the ini- 
tial dose, morning and evening, increased daily by the addition of two 
drops, up to sixty or seventy drops for an adult, daily. In the diseases 
for which it is prescribed, it is necessary, to secure curative effects, that 
the physiological action be produced. Planat has used this tincture 
successfully in chorea, epilepsy, eclampsia (infantile), and in painful 
contractures of the extremities. Gubler advises the dose of a mille- 
gramme of picrotoxin for subcutaneous use. He has observed that 
indurated spots result from the injections, but they slowly disappear. 

Authorities referred to : 

Browne, Dr. Crichton. The British Medical Journal, vol. i, 1875, pp. 409, 443, 
476, 540. 



•US EXCITO-MOTORS. 

Chirone and Testa. Annali. Univ. di Med. e Chirurg. Quoted in London Med. Rec- 
ord, October 15, 1880. 

Dujardln-Beaumetz. Annuaire de Therap. for 1876, p. 33. 

Gubler, Prof. A. Bull. Generalde Therap., 1875. 

Hammond, Dr. W. A. St. Louis Clinical Record, October, 1876. 

Hurd, Dr. Michigan Med. Neivs, February 10, 1881. 

Kohler, Prof. Dr. Bcrl. klin. Wochenschrift, No. 47, 1867. 

Murrell, Dr. William. The Practitioner, October, 1879, vol. xxiii, p. 241. 

Planat, Dr. Bull. Gen. de Therap., 1876. Also Annuaire de Therap., 1876, p. 29. 

Roeber, Dr. Archiv fur Physiol., etc., for 1869, p. 30. 

Ergota. — Ergot. The sclerotium of Claviceps purpurea, replacing 
the grain of Secale cereale Linne (Nat. Ord. Graminacem). (U. S. P.) 
Ergot de seigle, Fr. ; Mutterkom, Ger. 

Extractum Ergotce Fluidum. — Fluid extract of ergot. Dose, 3 ss 

— 3J- 

Vinum Ergotce. — Wine of ergot. Dose, 3 j — § ss. 

Ergotin. — This preparation must not be confounded with a con- 
stituent of ergot, supposed to be an active principle. The ergotin of 
the shops gets its name from "Bonjean's ergotin." It varies very 
much in strength, owing to faulty modes of preparing it, and is 
not (infrequently inert. As prepared by Squibb it is entirely soluble 
in water, and represents the powers of the drug. Ergotin (the aque- 
ous extract) is the most eligible preparation for hypodermatic injec- 
tion. From one to five grains may be injected at one time. In pre- 
paring it for this purpose, the quantity to be injected should be rubbed 
up with fresh distilled or rain water, and then passed through the filter. 
It is always better to prepare it whenever required. If it is necessary 
to preserve the solution, the addition of a little carbolic acid — one grain 
to four ounces — will usually suffice. The addition of glycerin is not 
necessary, except as a preservative fluid ; and is objectionable, because 
it greatly increases the pain which attends the subcutaneous injection. 

Composition.— Some confusion yet exists in regard to the con- 
stituents of ergot, notwithstanding recent advances in our knowledge. 
An unfortunate nomenclature is in part responsible for the confusion ; 
but the subject is difficult, and the views of chemists have differed much. 

Ergot contains about thirty per cent of a saponifiable, non-drying 
oil, with which is associated a small quantity of resin and cholesterin. 
When extract of ergot is treated with an alkali, a peculiar fishy odor 
is developed, due to methylamine, according to some authorities, and 
trimethylamine according to others. Ergot also contains lactic and 
phosphoric acids and phosphates. The two principles, ecbolina and 
ergotina, separated by Wenzeil in 1864, are not true alkaloids of ergot, 
and are said by Dragendorff to be identical. In 1830 a supposed al- 
kaloid was obtained by Wiggers, which he named ergotin, but this is 
not the true active principle. Unfortunately, an aqueous extract, pre- 
pared by Bonjean, was also named ergotin. Kohler has examined the 
ergotin of Wiggers and that of Bonjean, and finds that they are 



ERGOT. 449 

mixtures : the former containing the ingredients of ergot not soluble 
in water ; the latter, those that are soluble in water. According to 
Kohler, neither of these so-called ergotins represents the properties of 
ergot. More recently Dragendorff and Podwissotzky have gone over 
the chemistry of ergot anew, with different results. They have in- 
troduced new terms also, which add to the complications. The most 
important principles obtained by them are sclerotic or sclerotinic acid, 
and scleromiccin, the former existing in good ergot in the proportion 
of about four per cent, and the latter two to three per cent. Another 
alkaloid has lately been discovered by Tan ret, to which he has given the 
name ergotinine. This substance seems to be a genuine alkaloid ; but 
Kobert has proved that it is inert, or, at least, has no action on the uterus. 
It is a white, crystallizable solid, insoluble in water, and soluble in ether 
and chloroform. It is alkaline in reaction and has strong basic proper- 
ties, and combines with acids to form salts. It is an unstable substance, 
and in the air soon decomposes. The investigations of Kobert, made in 
Schmiedeberg's laboratory and published last year, have all the author- 
ity which the brilliant talents of the disciple and the immense knowl- 
edge of the great master can confer on any production. Robert's study 
of the chemistry of ergot resulted in the separation of two acids, 
ergotinic acid and sphacelinic acid, and an alkaloid, cornutine. 

Ergotinic acid is the principal part of the sclerotic acid of Dragen- 
dorff and Podwissotzky, mentioned above, and of Bonjean's ergotin. 
It has no effect on the uterus, but does act on the circulation in a man- 
ner unfavorable to the general purposes of the remedy. Sphacelinic 
acid is the most actively toxic, and is the principle that produces the 
ergot-gangrene. According to Recklinghausen, who made a careful 
investigation of the pathological state induced by it, the initial change 
takes place in the hyaline tissue of the intima of the blood-vessels ; 
the lumen of the vessels is encroached on, thromboses form, and ex- 
travasations of blood occur in various places. Hyaline degeneration 
occurs in the lens, also, and cataract is thus formed. These effects 
are increased by the stimulation of the muscular fiber of the arterioles 
lessening their caliber, and thus raising the general blood-pressure. 
It acts on the uterus powerfully, and is an abortifacient. Cornutine, 
the alkaloid, is contained in ergot in minute quantity. It causes tonic 
and clonic convulsions, and death is due to paralysis of respiration. 
The ecbolin of Wenzell contains more or less cornutine, and owes to 
it any active property that it may exhibit. Tanret's crystallizable 
ergotinine is not cornutine ; but if any given specimen proves to have 
active property, Kobert supposes it to contain cornutine. 

The most eligible preparation of ergot, Kobert asserts, is an ex- 
tract so prepared as to contain the sphacelinic acid and cornutine, and 
for which he proposes the name extraction cornuti secalis cornutino- 
sphacelinicum Koberti. Thus far this preparation, which is to be put 
forth bv Gehe, of Dresden, awaits the new crop of ergot. 
30 



450 EXCIT0-MOTORS. 

The composition of ergot has been so nearly arrived at that it will 
require but little additional investigation to decide finally. Mean- 
while, the practitioner can obtain the best results from the fluid ex- 
tract of the U. S. Pharmacopoeia, if honestly prepared from fresh and 
genuine ergot. 

The symptoms by which the physician may recognize the effects 
of the ergot administered, in any case requiring the exhibition of mass- 
ive doses, are partly subjective. The patient experiences more or less 
headache, with a sense of constriction of the forehead, singing in the 
ears, and a vertigo, which consists in a sensation of floating off. The 
pupils dilate, and are rather sluggish in their response to Stimulation ; 
the eyes appear suffused, and are sensitive to light ; the sense of hear- 
ing becomes abnormally acute, and loud sounds make a painful im- 
pression. The action of the heart is slowed, but the pulse is not tense, 
and the respirations are slower, with something of a sighing super- 
added. To this complex of symptoms must be added a feeling of 
anxiety, and a restlessness which is apparently due to the sensation of 
" fidgets," as it is commonly known — a feeling of unrest, which impels 
to constant movement of the limbs. As the effects increase, nausea 
comes on, and with it vomiting, that takes place suddenly, with little 
or no warning, the nausea and vomiting almost coincident. This cere- 
bral vomiting is to be distinguished from that which is attendant on 
the gastro-enteritis of cases of poisoning. 

Antagonists and Incompatibles. — The caustic alkalies and the 
metallic salts are chemically incompatible. Aconite, veratrum viride, 
tobacco, lobelia, and amyl nitrite (Shafer), antagonize the action of 
ergot on the circulation. 

Synergists. — Electricity, cold, digitalis, belladonna, are synergis- 
tic as regards the vascular system. Savin, gossypium, rue, borax, 
increase its parturient action. 

Physiological Effects. — In small medicinal doses ergot does not 
produce sensible physiological effects. In large doses it causes symp- 
toms referable to the gastro-intestinal canal, and to the cerebro-spinal 
axis. It is bitter to the taste, and excites more or less heat and dry- 
ness of the throat, followed by thirst, stomach-pain, vomiting, intesti- 
nal pain, and occasionally purging. These gastro-intestinal symptoms 
are unquestionably due to the local irritant action of the drug ; for, 
after death, in a few fatal cases which have resulted from its adminis- 
tration, there have been found patches of inflammatory redness in the 
stomach and intestines. 

The active constituents of ergot diffuse into the blood. What 
changes, if any, are caused in the composition of the blood, are at 
present quite unknown. Very characteristic effects are, however, pro- 
duced in the circulatory system : the action of the heart becomes 
slower, and an enormous rise takes place in the blood-pressure. This 
influence on the circulatory system modern research has shown to be 



ERGOT. 451 

due to the action of ergot on the vaso-motor nervous system ; it 
increases the action of this system, and causes a contraction of the 
arterioles. 

The dilatation of the pupil which follows is another evidence of 
this action. Pain in the head (usually frontal), dimness of vision, 
giddiness, and stupor, are also produced by it. The action of ergot 
on unstriped muscular fiber is further shown in the contractions of the 
parturient womb, the arrest of haemorrhage, and the difficulty of mic- 
turition, which follows its medicinal administration. The power of 
ergot to contract the arterioles has been repeatedly demonstrated in 
the web of the frog's foot. 

The phenomena above described, due to the administration of large 
medicinal or toxic doses, are known as acute ergotism. The peculiar 
morbid effects of ergot, when used for a long period of time as food 
(diseased grain), are known as chronic ergotism, which exists in two 
forms, the convulsive and gangrenous. Generally the convulsive form 
begins by vertigo, disorders of vision, tinnitus aurium, numbness of 
the fingers and toes, and afterward of the integuments of the body. 
These symptoms are followed by tetanoid contractions of the fingers, 
of the forearms on the arms, and of the arms against the chest ; of 
the toes on the palmar surface of the foot, of the leg on the thigh. 
The thoracic, abdominal, and diaphragm muscles are also tetanically 
contracted, and respiration becomes painful and difficult, and attacks 
occur similar to asthma. The intestinal muscles become affected by 
cramp, doubtless tetanoid in character, colics ensue, and diarrhoea ; the 
uterus in pregnant females takes on action, and abortion may result. 
The pulse is small, action of heart slow, and the surface cold. The 
appetite is generally ravenous. 

The tetanic spasms, at first separated by distinct intervals, become 
continuous, and opisthotonos or emprosthotonos is produced. Anaes- 
thesia (complete) of the surface succeeds to the tetanoid attacks, and 
gangrene of limited spots may occur. The organs of sense lose their 
sensibility and taste, hearing and smell are abolished. The pupils are 
dilated, sometimes unequal, and various disturbances of vision ensue. 
Epileptiform convulsions may occur in addition to the tetanoid spasms, 
delirium sets in, and complete insensibility at last supervenes. 

As has been shown by Lasegue and Tardieu, the gangrenous and 
convulsive forms of chronic ergotism are not separated by any well- 
marked pathological differences. The gangrenous form begins hy 
tingling, numbness, formication, an insupportable sense of fatigue in 
the members, an earthy hue of the skin, coldness of the surface ; 
nausea, vomiting, and diarrhoea, with intestinal cramps, then occur ; 
muscular contractions take place ; an eruption of vesicles filled with 
a dark ichorous fluid appears on one or more extremities, and gan- 
grene, dry or moist, quickly destroys the toes, the legs, the nose, or 
other parts. 



452 EXCITO-MOTORS. 

The phenomena of chronic ergotism are evidently due to two causes 
— to the dyscrasia which exists in the subjects of this malady, owing 
to insufficient food and bad hygienic surroundings, and to the action 
of the ergot of the diseased grain, in diminishing the blood-supply to 
the cerebro-spinal axis, to the vegetative organs, and to the skin and 
muscular system. 

To this general sketch of the actions of ergot, it may be well to 
add some particulars of its most important physiological properties, 
and some observations on the actions of the recently discovered active 
principles. The most conspicuous effect of ergot, and that on which 
depends its therapeutical applications, is the influence which it exerts 
over the vascular apparatus. It is an undoubted fact, in respect to 
which all the investigators agree, that ergot diminishes the number 
and alters the character of the cardiac pulsations. The frog's heart 
may be arrested in the diastole by the intravenous injection of a full 
dose. By Rossbach and Wernich it was observed that a vermicular 
or peristaltic motion was given to the heart of frogs. The arrest of 
the heart's action is attributed by Eberty to stimulation of the vagus 
and a consequent increase of the inhibition. By Rossbach it is referred 
to an action on the cardiac muscle. It is in a high degree probable, 
however, that the slowing and depression of the cardiac functions is 
due to the action of ergot on the cardiac ganglia. To this may be 
opposed the observation of Willebrand, that the normal or hyperto- 
phied heart so contracts under the action of ergot that the difference 
in size is appreciable by percussion ! There is no dispute in regard to 
the contraction of the arteries induced by ergot. It has been observed 
and measured by Wernich, Briesemann, and Holmes. The notion that 
ergot causes contraction of the arteries by stimulating the vaso-motor 
system and its muscular apparatus has long been entertained. An 
enormous rise in the blood-pressure has been stated to occur by Eberty, 
Kohler, and H. C. Wood, and their opinion was based on kymographic 
observations. Holmes, Hermann, and Wernich, on the other hand, 
maintain that the blood-pressure is actually reduced. Wernich shows 
that the veins are dilated, and that a great accumulation of blood takes 
place in them, while, at the same time, the arteries contract, not re- 
ceiving from the slowly acting heart sufficient blood. The contrac- 
tion of the arteries is not, therefore, an active contraction, as has been 
supposed, but a collapse, the result of deficient supply of blood, which 
has accumulated in the dilated veins. By the theory of vaso-motor 
stimulation, it was easy to explain the action of ergot on the muscular 
fiber of the uterus and intestinal canal. If, however, the blood-press- 
ure falls after the administration of considerable doses, as Handelin, 
Brown-Sequard, and others affirm, and the arterial contraction is 
not active, how explain the uterine and intestinal action of ergot ? 
This result is due to arterial anaemia (Wernich, Schlesinger, Mayer, 



ERGOT. 453 

etc.). It is now clearly established that active movements occur in 
the muscular fiber of the intestinal canal and uterus by inducing an 
arterial anaemia. According to this view, then, the active peristalsis 
and the uterine contractions which follow the exhibition of ergot are 
the result, not of a direct stimulation of the sympathetic system, but 
of the diminished cardiac energy, dilatation of the veins, and arterial 
anaemia. 

The action of ergot is not limited to the vascular apparatus. The 
arterial anaemia which it induces may serve to explain the cerebral 
effects which follow its free administration in man, but, besides these, 
the functions of the spinal cord and peripheral nerves undergo changes. 
In frogs ergot induces paralysis, beginning in the hind extremities, 
and thence involving all parts, the circulation and respiration being 
the last to yield. In warm-blooded animals the same effects are pro- 
duced, and, if the action continues, finally the cardiac and respiratory 
centers are paralyzed. By Zweifel these central effects are held to 
be the principal, and all others merely secondary. On the other hand, 
the depression in the motor and reflex functions of the cord may be 
explained by the arterial anaemia, which is an undisputed effect of 
ergot, how much soever the mechanism of its production may be dis- 
puted. Indeed, it must be admitted that the actions of ergot are still 
subjudice. The numerous and often diverse views which have been 
expressed may be in part explained by the character of the prepara- 
tions. There can be no doubt that the active constituents are un- 
stable, and hence the pharmaceutical products vary, not only in the 
degree, but decidedly also in the character, of the actions. In Koh- 
ler's investigation, in which he compared the ergotin of Wiggers and 
Bonjean, there were very wide differences between them. The ergotin 
of Bonjean — an aqueous extract — excites the vaso-motor center in the 
medulla and the cardiac inhibitory center, and very large doses para- 
lyze the heart, the muscular tissue losing its excitability to galvanism. 
Wiggers's ergotin has no effect on the vascular apparatus. In these ex- 
periments of Kohler, with which Eberty was associated, the power of 
ergot to increase the blood-pressure is an important point. The atten- 
tive reader will observe that in these experiments the heart was para- 
lyzed, and the irritability of its muscular tissue destroyed. Wiggers's 
ergotin causes cramps of the intestines, and violent inflammation of 
the gastro-intestinal mucous membrane, effects which never result 
from Bon jean's. Both kinds of ergotin lower the temperature, and 
both retard the respiration. Bonjean's ergotin diminishes the irri- 
tability of the peripheral motor nerves, and Wiggers's increases it. 
Both lessen the irritability of the sensory nerves. Kohler concludes 
that, when it is desired to slow the heart, contract the vessels, dimin- 
ish reflex actions, and lessen temperature, the ergotin of Bonjean 
should be used. 



464 EXCITO-MOTORS. 

The physiological action of sclerotinic acid has been carefully 
studied by Nikitin in Rossbach's laboratory. He starts out by affirming 
the identity of action between this principle and ergot. In frogs the 
reflex excitability of the spinal cord is reduced, then destroyed, but 
in warm-blooded animals it is reduced only. It does not affect the 
irritability of the motor nerves, nor the contractility of the muscles, 
but when brought in contact with sensory nerves, paralyzes them. 
Sclerotinic acid depresses the action of the heart in frogs, but not in 
mammals. In toxic doses it lowers the blood-pressure and reduces 
the temperature. The respiration is slowed, and, when toxic doses 
are given, the movements of respiration cease before the heart stops. 
The peristaltic movements are increased in warm-blooded animals, 
and the uterus, whether gravid or not, is excited to action. Death is 
due to paralysis of respiration. 

Sclerotinic acid has been freely prescribed by Yon Hoist, who finds 
it possessed of a high degree of activity, but other clinicians have 
been less successful — thus Robert, of Halle, finds it can not be substi- 
tuted for ergot. In my own experiments, I have found it produce 
effects, but not those of ergot proper. Sclerotinic acid is separated by 
alcohol, but Handelin, who had investigated this subject under the 
superior direction of Schmiedeberg, finds that ergot loses none of its 
activity by being extracted with alcohol. Handelin's experiments, 
made with an aqueous extract, present some points of interest. He 
found that small doses cause anaesthesia and impair the power of co- 
ordination, and large doses paralyze reflex and voluntary motions. As 
the peripheral nerves are unaffected, the paralysis is centric. Small 
doses lower the blood-pressure temporarily, and large doses perma- 
nently. The pulse is at first quickened, and then declines, becoming 
more and more slow until the heart is arrested. 

The first trials with Tanret's crystallized ergotinine were made by 
Dr. M0I6, who found it as effective in uterine haemorrhage as ergot. 
The amount that he administered did not exceed four milligrammes 
in twenty-four hours. Galippe and Budin have also experimented with 
ergotinine on frogs, cats, and dogs, and produced many of the effects 
ascribed to ergot, namely, slowing of the pulse, reduction of tempera- 
ture, paralysis, and convulsions. Peton, another investigator, has also 
experimented with ergotinine, the results of the action being contrac- 
tion of the arteries, restlessness, trembling, diarrhoea, etc. 

An examination of the results obtained from the experimental and 
clinical trials with the so-called principles and alkaloids of ergot dem- 
onstrates that in no single one are contained all the powers and prop- 
erties of the drug. It is also evident that ergot, and those principles 
possessing its powers most nearly, depress the heart, and lower rather 
than elevate the tension of the arteries. The contraction of the ar- 
teries is not, therefore, an active contraction ; and, as the blood accu- 



ERGOT. 455 

mulates in the veins, there is an anaemia of the cerebro-spinal axis and 
of the organic muscular fiber. To this condition of things may be 
referred the phenomena resulting from the exhibition of ergot. 

Therapy. — The only diseases of the intestinal canal to which ergot 
is applied are chronic diarrhoea and dysentery. It is best adapted to 
those cases in which the chronic succeeds to the acute form, and is not 
so serviceable in the chronic diarrhoea of warm climates, which has de- 
veloped slowly, without preliminary acute symptoms. Ijk Ext. ergotae 
fluidi, 1 iijss; tinct. opii deodor., § ss. M. Sig. : A teasp oonf id three 
times a day. P} Ergotinae (aq. ex.), 3] ; ext. nucis vomicae, gr. v; 
ext. opii, gr. v. M. Ft. pil. no. xx. Sig. : One every four or six 
hours. This last prescription is highly useful in persistent chronic 
diarrhoea. 

Dr. L. G. Andrew has treated acute dysentery successfully with 
the fluid extract of ergot. Dr. W. C. Dabney, of Virginia, urges the 
local application of fluid extract of ergot in affections of the mucous 
membrane characterized by enlarged vessels, as, conjunctivitis, cervi- 
citis, pharyngitis, etc., and by Dr. Eldridge it has been applied to the 
treatment of gonorrhoea, acne rosacea, etc. The theory of its action 
in these maladies is the artificial anaemia which it induces in the arterial 
vessels. Inflammation can not go on, because the blood-supply is in- 
adequate. In the local application the fluid extract of ergot is used. 
In most cases this may be applied directly to the membrane undiluted. 
The aqueous extract, or ergotin, may be utilized for these purposes 
also ; made into a paste more or less thick according to the character 
of the surface, it may be plastered on the affected part. 

Ergot in the form of the fluid extract, with or without mix- vomica, 
will often arrest the bleeding of haemorrhoids, and cause such a con- 
traction of the vessels in recent cases as that the symptoms may en- 
tirely disappear. This treatment is especially serviceable in the haemor- 
rhoids which succeed to delivery. Relaxation of the sphincter ani and 
prolapsus of the rectum may be ameliorated and, when recent, cured 
by the same means. 

Ergot is a useful remedy in cases of enlarged heart (dilated cavities) 
without valvular lesion. It may be given with digitalis : ^ Ext. 
ergotae fluidi, § iijss ; tinct. digitalis, § ss. M. Sig. : A teaspoonful 
three times a day. There is now no longer any doubt as to the value 
of ergot in aneurisms, and especially in internal aneurisms beyond the 
reach of surgical treatment. In these cases the methodus medendi is 
as follows : ergot slows the action of the heart, and causes such a de- 
gree of contraction of the arterioles as to produce a great increase of 
the blood-pressure, whence it follows that the coagulation of the blood 
in the aneurismal sac is greatly promoted. It is quite conceivable that, 
as respects small aneurisms of the peripheral main arterial trunks, 
ergot may effect a cure in the mode suggested by Langenbeck, viz., 



456 EXOITO-MOTORS. 

by direct contraction, under the influence of the ergot, of the unstriped 
muscular fibers in the affected portion of the vessel. With the use of 
ergot should be enjoined rest in the recumbent posture, and other 
measures to favor hyperinosis and the coagulation of the blood in the 
aneurismal sac. 

The recent, more accurate notions, regarding the physiological ac- 
tion of ergot, have led to its employment in various forms of hemor- 
rhage. With suitable means for improving the quality of the blood, 
ergot is very serviceable in the hemorrhagic diathesis ; but it is not 
to be relied on alone. The special indication for its use in haemorrhage 
is a want of tonicity of the vessels. It is used in epistaxis, hcemoptysis, 
renal, intestinal, and uterine hemorrhage. Large doses of a suitable 
preparation are necessary ; for, if the drug be inert, nothing but dis- 
appointment will be experienced from its use, and small doses do not 
produce sufficient effect. From half a drachm to a drachm of the pow- 
dered ergot, or one to two drachms of the fluid extract, given every 
half -hour or hour, will be necessary in urgent cases. As powdered er- 
got rapidly loses its activity by keeping, the fluid extract should be 
used, and only that prescribed which has been carefully made from the 
fresh drug. Attention to these precautions will insure more uniform 
results in hemorrhage than have hitherto been obtained. In hemop- 
tysis the fluid extract of ergot may be given with other appropriate 
remedies ; IJ Ext. ergotae fluidi, § iij ; ext. ipecac, fluidi, tinct. opii 
deodor., aa § ss. M. Sig. : A teaspoonful every half-hour or hour. 
When the sputa are heavily charged with blood, and there is no de- 
fined haemorrhage, the following may be used : 3 Ergotinae (aq. ex.), 
3] ; pulv. ipecac, gr. x ; acid, gallic., 3 j. M. Ft. pil. no. xx. Sig.: 
One every hour or tioo. In renal hemorrhage, the following is a use- 
ful formula and generally very effective : fy Ext. ergotae fluidi, tinct. 
krameriae, aa § ij. M. Sig. : A teaspoonful every hour or two. Or, 
ergotine may be prescribed with gallic acid, as in the prescription above 
given. 

The indication for the use of ergot in menorrhagia is the existence 
of the large, spongy uterus — the condition of things which depends on 
subinvolution of the icomb. Menorrhagia, when caused by ovarian 
excitement, is usually more promptly relieved by bromide of potas- 
sium, and metrorrhagia,' produced by fibroids or fungous granulations, 
is, in the author's experience, much more decidedly held in check by 
diluted sulphuric acid than by ergot. 

When there is reason to believe that vertigo, epistaxis, headache, 
and tinnitus aurium, are due to miliary aneurisms of the intra-cranial 
arterioles, most favorable results can be produced by the use of ergot. 
Also, when there is a sluggish and partially obstructed state of the 
intra-cranial veins, usually due to chronic arteritis, and accompanied 
by hebetude of mind, giddiness, epistaxis, etc., these symptoms are 



ERGOT. 457 

made to disappear, and the mental condition is much improved by 
ergot. 

Dr. Crichton Browne, a physician of large experience in these dis- 
orders, finds ergot a very useful remedy in certain forms of mental 
disease, for example, " in recurrent mania, chronic mania with lucid 
intervals, and in epileptic mania." In these mental disorders he as- 
sumes the existence of cerebral hyperemia, and he deduces the cura- 
tive value of ergot from its power to cause contraction of the vessels. 

Migraine, when the attacks are accompanied by suffusion of the 
face, injected conjunctiva?, and a full pulse — the congestive form — is 
cured by ergot, and Dr. Kitchen indeed extends its use to almost all 
kinds of headache. 

In epidemic cerebrospinal meningitis, ergot is one of the remedies 
from which the best results are to be expected. In congestion of the 
spinal meninges and the cord, and in acute myelitis, this remedy has 
probably been more uniformly successful than any other, but it must 
be given in large doses. 

Excellent results have been obtained from the use of ergot in acute 
inflammation of the conjunctiva, in blepharitis, and in the phlyctenu- 
lar ophthalmia of children. 

The long-continued use of ergotin has achieved remarkable results 
in chronic metritis. Uterine fibroids and polypi of the uterus are 
greatly benefited in two modes by ergot : uterine action is set up, by 
which the growth is either compressed or extruded, and the nutrient 
vessels are so diminished in caliber that atrophy of the morbid growth 
occurs. The numerous reported instances of success by this treatment, 
and the author's personal experience of its utility, justify him in urging 
a trial of this remedy in uterine fibroids and polypi. 

In congestive dysmenorrhea, much good may be expected from the 
use of ergot when the menstrual molimen begins. Jjk Ext. ergotse 
fluidi, 3 vij ; tinct. gelsemii, 3 j ; tinct. aconiti rad., gtt. xvj. M. 
Sig. : A teaspoonful every two, three, or four hours. Amenorrhea, 
when dependent on plethora, has been cured by ergot. 

When incontinence of urine, nocturnal or diurnal, is caused by a 
paretic or paralytic state of the sphincter vesicce, relief may be confi- 
dently expected from the use of ergot. The fact that one of the ill 
results of the administration of ergot in large doses is an inability to 
void the urine, is an interesting explanation of the methodus medendi 
of ergot in these cases. 

Ergot is one of the most satisfactory remedies in the treatment of 
spermatorrhoea. It is not useful when the losses are due simply to 
plethora. Its curative value is especially exhibited in those cases in 
which the erections are feeble and infrequent, the intromittent power 
wanting, and the testes relaxed and deficient in secretory activity. 

Paralysis of the bladder, the result of over-distention, and occasion- 



458 EXCITO-MOTORS. 

ally when due to cerebral or spinal lesion, is greatly benefited or cured 
by ergot. 

Ergot was first employed by Da Costa in the treatment of diabetes 
insipidus, and a number of cases have been cured by Murrell, Saun- 
ders, and others. The remedy must be perseveringly used, and in full 
doses, up to the stomach capacity or evidence of physiological action. 

Heitzmann has found ergot extremely useful in acne rosacea, and 
other forms of acne. He uses Squibb's fluid extract of ergot mixed 
with glycerin and water, giving 3 ss internally, daily. 

Ergot in Obstetric Practice. — It is no longer a matter of doubt 
that ergot promotes uterine contractions ; that it originates them with- 
out previous effort of the womb, is questionable. The contractions 
due to ergot differ from the spontaneous, natural contractions, in being 
less rhythmical and more tetanic. When large doses of ergot are used, 
a continuous expulsive effort may be produced. Ergot is indicated in 
labor when there is uterine inertia, the first stage being completed, 
and no obstacle existing at the outlet. If given before dilatation is 
completed, the perinaeum rigid, and the ostium vaginw not relaxed, dis- 
astrous consequences may ensue, both to mother and child. On the 
part of the mother, the violent and continuous pains — the resistance in 
front remaining — may cause a rupture of the womb, or the resistance 
may be overcome by laceration of the perinaeum. On the part of the 
child, it arrests haematosis, partly by direct action on the placental 
blood, and partly by the continuous compression of the body ; but the 
chief danger is paralysis of the foetal heart. 

It is highly approved by obstetricians at the present time to admin- 
ister a dose of ergot at the conclusion of the second stage of laoor, to 
insure firm uterine contractions. This practice is held to be the more 
necessary when previous experience justifies the apprehension of trou- 
blesome haemorrhage. When post-partum hcemorrhage occurs, it is 
universally conceded to be the proper thing to administer a full dose 
of ergot ; but at the same time other measures must be resorted to in 
order to procure firm uterine contractions, on which alone depends the 
safety of the patient. In these conditions the ergot is usually admin- 
istered in substance — one scruple to a drachm of coarsely-powdered 
ergot infused in a cup of hot water, the whole being drunk by the pa- 
tient. From 3 j to § j of the fluid extract may be given instead — the 
official preparation representing a grain of ergot to the minim. 

The Hypodermatic Injection of Ergotin. — The subcutaneous 
injection of ergot has become so important a therapeutical resource 
that it is necessary to treat the subject in a separate division. The 
solution employed for this purpose is usually as follows : I> Ergotinae 
(aq. ex.), 3 j ; glycerini, 3 j ; aquae destil., 3 vij. M. Sig. : Eight 
minims contain one grain of ergotin. Squibb has prepared " an ex- 
tract of ergot which is almost entirely soluble in cold water, and rep- 



ERGOT. 459 

resents good rye ergot in the proportion of one grain of extract for 
five grains of ergot. Sixty grains of this extract, dissolved in two 
hundred and fifty minims of water — the solution filtered, and made up 
to three hundred minims by passing water through the filter to wash 
it and the residue upon it — makes a solution which represents ergot in 
the proportion of minim for grain, and is of the same strength as the 
fluid extract of ergot, but is free from alcohol or other irritant sub- 
stance." This preparation the author has found to be admirably 
adapted for subcutaneous administration. When the aqueous extract 
of ergot of good quality can not be obtained, the fluid extract may be 
used. 

The rules for the administration of ergot are the same as for other 
agents applied in this way. 

In the treatment of hemorrhage, when a prompt effect is desired, 
the hypodermatic injection is preferable to the stomach administration. 
In hemoptysis, the injection may be practiced while suitable remedies 
are administered by the stomach. In hcematemesis, especially if the 
stomach be irritable, better results may be obtained by subcutaneous 
use of ergot than by any form of internal medicine. In post-partum 
hcemorrhage, when to await the action of ergot may endanger the life 
of the mother, the subcutaneous administration should be resorted to. 
The happy results which have attended this mode of administration 
in serious cases, demand that the accoucheur be provided with the 
necessary appliances for the hypodermatic injection of ergot in every 
obstetrical case. This mode of using ergot is not only prompter in 
results, but is more effective in securing uterine contractions and arrest 
of hemorrhage. 

The good results which are obtained from the stomach administra- 
tion of ergot in subinvolution of the uterus and in chronic metritis, 
are much more quickly and decisively obtained from the subcutaneous 
administration. Since the memoir of Hildebrandt appeared, numerous 
cases of successful treatment of uterine fibroids by hypodermatic injec- 
tion of ergotin have been published. There seems to be no longer 
any doubt that this agent administered in this way, and less effectively 
and for a much longer period by the stomach also, has the power to 
arrest the growth of uterine fibroids, to cause them to atrophy, or to 
set up such a degree of uterine action as to compel their extrusion as 
polypi from the uterine cavity. It has, of course, long been known 
that ergot administered by the stomach may induce such a degree of 
uterine contraction as to expel a polypus.. In those instances in which 
the hypodermatic injection fails to arrest the growth of a polypus, 
notable improvement in the amount of the haemorrhage and of the 
muco-purulent discharge is, at least, a result of the treatment. The 
author is enabled to speak from personal observation of the excellent 
results obtained by this mode of treatment in many cases. 



460 EXCITO-MOTORS. 

From two to six grains of the aqueous extract of ergot (ergotin) 
may be injected under the skin in these cases of uterine fibroids on 
alternate days, or thrice or twice each week. The abdomen is usually 
preferred as the site of the injection. More or less pain is experienced 
at the moment of the insertion of the solution, and an indurated spot, 
which may be more or less sore, will remain for a week or more. Sup- 
puration may result from the injection, but it is not a frequent accident. 

The hypodermatic injection is an effective mode of treating vari- 
cocele. About two grains of the extract in solution is a suitable dose. 
The needle is inserted so that its point w T ill rest among the dilated 
veins, but care must be taken not to puncture a vein. Very severe 
pain follows, and there may be great faintness, but the effects subside 
in a few hours unless considerable swelling should ensue, which is 
quite usual. A single injection may cure a very extensive varicocele, 
and more than two are rarely necessary. Varicose veins in other 
parts, especially of the inferior extremities, have been cured by the 
same treatment. The following is the mode of proceeding in these 
cases : the needle is inserted under the skin, in close juxtaposition to 
the enlarged vein, and the fluid is so injected as to lie alongside of the 
vein, but not to enter it. The cure which follows in many of these 
cases has been ascribed to the inflammatory swelling which takes place, 
but there is, doubtless, besides this effect, a dynamical influence ex- 
erted on the vessel-walls. 

It has lately been asserted that deficient erections and loss of the 
capacity for coitus are not unfrequently due to enlargement of the 
dorsal vein of the penis, and consequent too rapid emptying of the 
veins of the erectile tissue. Acting upon this plausible suggestion, the 
author has practiced the hypodermatic injection of ergotin about the 
dorsal vein of the penis, and he has had apparently excellent results. 

Before closing this article, it may be advisable to recall to the read- 
er's attention the fact that the hypodermatic injection of ergot, or its 
internal administration in large doses, may cause such tonic contrac- 
tion of the sphincter vesicce as to render micturition impossible. Care- 
ful inquiry and frequent examinations of the hypogastric region should 
be made during a course of ergot preparations. 

Authorities referred to : 

Bailly, Prof. M. Ergot, Ergotine — Action physiologique, etc. Bulletin General de 
Therapeutique, vol. lxxviii, pp. 433, 481, 529. 

Briesemann, Dr. C. Schmidt's Jahrbucher, vol. cliii, p. 30. 

Browne, Dr. Crichton. The Practitioner, vol. vi, p. 321. 

Cyr, Dr. Jules. Traite de V Alimentation, Paris, 1869, article Ergotisme, p. 425, 
et seq. 

Dctoit, Dr. Schmidt's Jahrbucher, vol. cliv, p. 315. 

Eberty, Dr. P. Schmidt's Jahrbucher, vol. clviii, p. 126. 

Eulenburg, Dr. Albert. Lie hypodermatischen Injection der Arzneimittel, 1867, 
p. 283. # 



USTILAGO. 461 

Fluckiger and Hanbury. Pharmacographia, p. 672, et seq. 

Hildebrandt, Prof. Ueber die Finwirkung Subcutaner Injectionen von extr. secal. 
cornut. aq. auf Fibro-Myome des Uterus. Berliner klinische Wochenschrift, No. 25, 18*72, 
p. 29. 

Holmes, Dr. Ch L. Schmidt's Jahrbucher, vol. clviii, p. 126. 

Husemann, Drs. Theo. und Aug. Die PJlanzenstoffe ; Alkaloide des Mutterkorns, 
p. 520. 

Husemann, Dr. Theod. Handbuch der gesammten Arzneimettellehre, Berlin, 1875, 
p. 203. 

Kitchen, Dr. Daniel. The American Journal of Insanity, July, 1873. 

Kobert, Prof. Dr. Archiv fur experiment. Pathol, und Pharmacol, for 1886, and 
The Practitioner, for 1886. 

Langenbeck, Prof. Berliner klinische Wochenschrift, No. 6, 1869. 

Luton, Dr. A. Gazette Hebdomadaire, October, 1871. 

Meadows, Dr. Alfred. The Practitioner, September, 1868. 

Nicol, Dr. Patrick, and Isaac Mossop. On the Action of Certain Neurotics on the 
Cerebral Circulation. British and Foreign Medico- Chirurgical Review, July, 1872. 

Schneider, Dr. Berliner klinische Wochenschrift, vi, 36, p. 390. 

Ustilago. — Ustilago. Ustilago maydis Leveille (Nat. Ord. Fungi) 
grows upon Zea mays Linne (Nat, Ord. Graminacew). 

Extractwm Ustilaginis Maydis Fluidum. — Fluid extract of usti- 
lago. Dose, iti,x — 3 j. 

Composition. — No proper investigation has yet been made of the 
chemical constitution of ustilago. Some of the ingredients found in 
ergot have been detected, as secaline so called, and trimethylamine / 
but the latter is regarded by others as a dec6mposition product and 
not existing preformed. Besides other substances, Parsons has sepa- 
rated an acid, which he regards as similar to the sclerotic acid of 
Dragendorff, and a substance soluble in ether but not in alcohol. 

Physiological Actions. — Several important investigations of 
the actions of ustilago have been made in the laboratory of experi- 
mental therapeutics of Jefferson Medical College, which agree for 
the most part with the account to follow, and which we owe to Dr. 
Hoffman, whose work was done in the college laboratory three years 
ago. 

The researches above referred to will appear in a special volume, 
now preparing. 

Both in cold- and warm-blooded animals, ustilago acts as a spinal 
excitant, causing convulsions of a tonic character. It also heightens 
sensibility and the reflex function, so that the least irritation of the 
skin induces general tonic convulsions of the tetanic or strychnic 
character. Frequent irritation and repeated convulsions rapidly ex- 
haust the animal. On the other hand, quiet, darkness, and relief 
from all irritation, diminish the severity of the convulsions, and pro- 
long life, if not prevent a fatal result. Death may ensue in a con- 
vulsion by tetanus of the respiratory muscles. Muscular tremors, 
general, occur in warm-blooded animals, and muscular weakness 



462 EXCITO-MOTORS. 

(paresis) appears in the intervals between the convulsions. The irri- 
tability of the motor nerves, and, toward the end, of the sensory- 
nerves also, declines, but is not entirely lost, and the contractility of 
the muscles lessens semewhat. That the convulsions are spinal, is a 
fact proved by destroying the cord in a frog before administering 
the medicament, when no muscular action of any kind takes place. 
Section of the medulla or decapitation does not prevent the occur- 
rence of the convulsions. 

Ustilago slows the heart, and by numerous control experiments 
this action was shown to be due to stimulation of the pneumogastric 
and its terminal ganglia. It dilates the pupil, and affects the acute- 
ness of vision for near objects. 

We have no exact data in regard to the action of this agent on the 
uterine system. An impregnated cat, dying by a merely lethal dose 
slowly, did not abort ; but it is said that pregnant cows and bitches, 
after eating ustilago, have dropped their young. 

The modes of dying are two : in the tetanus ; by exhaustion. In 
the former, the respiration is arrested, violent tonic extension of the 
voluntary muscles takes place, the head being drawn back, the toes 
incurved. In the latter there is gradually increasing paresis between 
the convulsions, and slowing of the heart's action. The difference is 
largely due to the dose and rapidity of administration. A lethal dose 
for a rabbit weighing 25 ounces seems to be one drachm of the fluid 
extract. 

Digitalis. — The leaves of Digitalis purpurea Lirine (Nat. Ord. 
Scrophulariacece), from plants of the second year's growth. (IT. S. P.) 
Feuilles de digitate, Fr. ; Fingerhutblatter, Ger. 

Abstr actum Digitalis. — Abstract of digitalis. Dose, gr. ss — gr. j. 

Infusum Digitalis. — Infusion of digitalis contains 3 parts each 
of digitalis and cinnamon, infused in boiling water ; after two hours' 
maceration, is strained ; then 15 parts of alcohol added, and finally 
sufficient water to make up to 200 parts. Dose, 3 ij — 3 ss. 

Fxtractum Digitalis Fluidum. — Fluid extract of digitalis. Dose, 

mj— miij. 

Fxtractum Digitalis. — Extract of digitalis. Dose, gr. ss — grs. ij. 

Tinctura Digitalis. — Tincture of digitalis. Dose, tti v — 3 j. 

Composition. — Digitalis contains an active principle, digitaline. 
This exists in the amorphous and crystalline form. The amorphous 
form — the digitaline of Homolle and Quevenne — possesses consider- 
able activity, and, according to some authorities, is quite equal to 
the crystalline in strength. The crystalline digitaline (Nativelle's 
digitaline), physiological investigations have shown, is really an act- 
ive principle which represents all of the powers of the drug. This 
occurs in needle-shaped crystals, and has an extremely bitter taste. 



DIGITALIS. 463 

According to Schmiedeberg, digitalis contains digitonine, which 
strongly resembles saponine ; digitaline, which is insoluble in water, 
and is the chief constituent of Homolle and Quevenne's digitaline ; 
digitale'in, which is readily soluble and has the same action as German 
digitaline ; digitoxine, the most powerful, and is the principal constit- 
uent in Nativelle's digitaline. Koppe has examined the action of digi- 
taline, digitalem, and digitoxine, and finds that they agree in their 
action, and with the crude drug, but differ in degree of activity. 

Digitalinum. — Digitaline. A white, or yellowish- white powder, 
without odor, and having a very bitter taste. Dose, -^ — -fa of a 
grain. 

Antagonists and Incompatibles. — The cinchona preparations, 
acetate of lead, the sulphate and tincture of the chloride of iron, are 
chemically incompatible. Tannic acid and the preparations containing 
it diminish the physiological activity of digitalis. Opium, aconite, 
lobelia, and the cardiac paralyzers, antagonize some of the actions of 
digitalis, but the antagonism does not extend throughout the whole 
range of their influence. The most complete physiological antago- 
nism exists between digitalis and saponine (Kohler), the active princi- 
ple of Saponaria officinalis, closely allied to senegine. Aconite antag- 
onizes the cardiac action of digitalis, and morphine, also, to a less 
degree. 

Synekgists. — Cold, ergot, belladonna, increase the physiological 
activity of digitalis. 

Physiological Action. — Digitalis has a disagreeable, bitter taste. 
In considerable doses, of the infusion, for example, it disturbs the 
stomach and gives rise to nausea and vomiting, and frequently purges. 
Loss of appetite results from its medicinal administration in some 
subjects, even when the quantity is small ; but, in others, the appetite 
is increased. The active constituents of digitalis diffuse into the 
blood, but nothing is definitely known as to the action of this agent 
on the composition of the blood, or the influence which it has, if any, 
on the morphological elements. 

On the heart digitalis exerts a peculiar action which requires atten- 
tive examination : it prolongs the diastole and increases the vigor of 
the systole. A lethal dose arrests the heart in systole, inducing a tetan- 
ic state of the heart-muscle. While digitalis increases the power of 
the systole, the diastole is prolonged, hence the number of pulsations 
per minute is reduced. With ordinary medicinal doses this slowing of 
the heart may be considerable, and the pulsations may descend to fifty 
or even forty per minute. Microscopic examination of the mesentery 
(Ackermann) and of the web of the frog has definitely ascertained 
that a marked contraction of the arterioles takes place under the influ- 
ence of digitalis. The increased power of the systolic contraction of 
the heart and the greatly-increased resistance in front from a narrow- 



464 EXCITO-MOTORS. 

ing of the caliber of the vessels produce, as might a priori be ex- 
pected, a considerable rise of the blood-pressure. When the pulse is 
greatly reduced by the administration of large medicinal doses, a 
change from the recumbent to the upright posture causes a remarkable 
increase in the number, and diminution in the force, of the cardiac pul- 
sations. When lethal doses, short of a sudden toxic effect, have been 
experimentally administered, the slowing of the heart and rise of ar- 
terial tension first produced are succeeded by a quick, feeble pulse, and 
fall in the blood-pressure. These results are obviously due to the loss 
of power (paresis) which results from over-stimulation. 

A temporary rise of temperature follows the administration of a 
lethal dose of digitalis, but this rise is soon succeeded by a marked and 
sustained reduction. Owing to the increased resistance from diminu- 
tion of the caliber of the arterioles, the actual energy expended by the 
heart is in part converted into heat. Subsequently the slowing of the 
circulation, especially through the lungs (Traube), hinders the combus- 
tion process, and hence the fall of temperature. 

Digitalis in full medicinal doses produces headache, a band-like feel- 
ing around the forehead, dizziness, disturbances of vision (mistiness, 
vibratory movements of external objects, chromatic dispersion, etc.), 
drowsiness, languor, and a sense of weariness, and it may even cause 
hallucinations, illusion, and delirium. Digitalis lessens the reflex func- 
tion of the cord, lowers the sensibility of the nerves, motor and sen- 
sory, and impairs the electro-contractility of muscles ; but these effects 
are not produced by medicinal doses, but are toxic in character. 

As might be anticipated from a study of its physiological actions, 
digitalis acts like ergot on the enlarged uterus ; it stimulates to ener- 
getic contraction the muscular fibers, and in this way arrests uterine 
haemorrhage. On the genital organs of man it has a similar action ; by 
diminishing the blood-supply to the erectile tissue it lessens the power 
of erections, and, secondarily, affects the venereal appetite, producing 
anaphrodisia. 

Considerable difference of opinion exists as to the influence of digi- 
talis on the function of nutrition — the metamorphosis of tissue. By 
some an increase in the production of urea, by others a diminution, has 
been noted. The truth, most probably, is that it has no real influence 
on urea formation, and that the variations observed are accidental. The 
phosphoric acid and chlorides are diminished. In health digitalis af- 
fects but little the water of the urinary secretion ; according to some 
the water is diminished, according to others increased. It is difficult 
to reconcile these opposing statements, in view of the fact which has 
recently been ascertained by Brunton, that the diuretic action of digi- 
talis in dropsy is not due to the increased blood-pressure, but to a spe- 
cial action on the Malpighian tufts. 

Therapy. — Before entering on the therapeutical applications of 



DIGITALIS. 465 

digitalis, there are several practical points with regard to the quality 
of the drug which require attention. Disappointment in the use of 
digitalis is frequently experienced, in consequence of the inferior qual- 
ity of the drug prescribed. The wild digitalis is better than the culti- 
vated. In this country much of the digitalis found in the shops is the 
plant cultivated and put up by the Shakers. It is very uncertain, and, 
according to the author's observation, usually inert. The English digi- 
talis, and the preparations made from it, should alone be prescribed. 

Digitalis has an undoubted power to arrest haemorrhage (Ley den). 
The mechanism of its action is similar to that of ergot ; it slows the 
action of the heart and contracts the arterioles. In hemoptysis it is 
especially useful in the following state of things : frequent expectora- 
tions of bloody mucus, with occasionally a mouthful of florid blood, 
accompanied by fever. This group of symptoms is dependent on 
transudation from a number of small vessels about the site of a pneu- 
monia due to a tubercular or caseous deposition. The same kind of 
expectoration, due to pulmonary congestion from mitral regurgita- 
tion, is amenable to the same treatment. In uterine haemorrhage digi- 
talis is also serviceable, but it is more especially indicated in menor- 
rhagia and metrorrhagia of plethoric subjects. Like ergot, digitalis 
has the power to induce uterine contractions, and hence it has been 
used successfully to arrest post-partum haemorrhage. Cases of menor- 
rhagia, of a peculiarly obstinate kind, are caused by mitral regurgi- 
tation or stenosis, the mechanical result being to increase the blood- 
pressure in the venous system of the uterus. Digitalis is the appro- 
priate remedy in such cases. Granules of digitaline may be prescribed 
for some days previously to the occurrence of the menstrual molimen, 
but during the attack the infusion of digitalis is more serviceable. In 
cases of haemorrhage, generally speaking, the infusion is the most ef- 
fective form in which to employ digitalis. If the symptoms are urgent, 
a tablespoonful of the infusion may be given every half -hour until 
four doses are taken. In ordinary cases a tablespoonful of the infu- 
sion twice a day is a sufficient quantity to maintain a constant physio- 
logical effect. In the treatment of haemorrhage, digitalis may be 
combined with other remedies which are synergistic. ^ Infus. digi- 
talis, f ij ; tinct. krameriae, ext. ergotae fluidi, aa § j. M. Sig. : A 
tablespoonful pro re nata. 

In purpura and the hemorrhagic diathesis, digitalis is useful when 
given conjointly with restorative medicines ; but, as a dyscrasia exists 
on which the extravasations of blood depend, it is obviously neces- 
sary to correct this state of things, in order that the patient shall 
be benefited by a remedy which gives tone to the heart and vascular 
system. 

The most important uses of digitalis are in cardiac diseases. In 

general terms it may be said that it is indicated when the action of the 
31 



466 EXCITO-MOTORS. 

heart is rapid and weah and the arterial tension low, and is contrain* 
dieated xchen the action of the heart is vigorous and the arterial ten- 
sion high. 

In simple hypertrophy, which is compensatory, digitalis has no 
utility. In stenosis of the aortic orifice, with compensatory hypertro- 
phy, it is not only useless, but it may give rise to serious symptoms, 
and even cause a fatal result, if administered in doses sufficient to 
produce physiological effects (Fernet). When stenosis of the aortic 
orifice leads to incompetence and regurgitation of the mitral, then 
digitalis may be used with advantage. As respects the nature of the 
cardiac lesion merely, digitalis is useful in dilated heart with incom- 
petence of the mitral, in disease of the mitral orifice with stenosis or 
regurgitation, and in dilatation of the right heart with incompetence 
of the tricuspid. As respects the mechanical difficulties which ensue 
from cardiac lesions merely, digitalis is useful, by reason of the in- 
creased power which it gives the auricles and ventricles to empty their 
respective cavities, and the longer intervals between the pulsations, 
which enable the auricles more perfectly to discharge their contents 
into the ventricles. The mechanical difficulty consists in a deficiency 
of blood (ischcemia) on the arterial side, and a stasis of blood on the 
venous side, of the systemic and pulmonary circulation. Digitalis, 
therefore, assists in the " compensation," or, in other words, by its ac- 
tion on the heart restores the mechanical balance of the circulation, 
deranged by the cardie lesions. As respects the rational symptoms of 
heart-disease, digitalis is useful when the action of the heart is rapid 
and weak, the tension of the pulse low, when there are cough, diffi- 
culty of breathing, a dusky countenance, pulsating jugulars, scanty 
and high-colored urine, and general dropsy. As a rule, it may be 
stated that the rational signs furnish more conclusive indications of 
the need of digitalis than the physical. If given in suitable cases, the 
action of digitalis in heart-diseases is most conspicuous for good ; but 
careful consideration should be given to the conditions detailed above 
if the practitioner would procure thoroughly satisfactory results. The 
form in which digitalis is prescribed is most important. The infusion 
is the best form in cases of cardiac disease with dropsy. It should 
be given in tablespoonful doses, twice a day, until some characteris- 
tic physiological effects are produced. After the subsidence of the 
severe symptoms, digitaline-granules may be substituted for the infu- 
sion, or the powder of the leaves may be given in pill-form. As very 
decided anaemia is present in these cases, the best results are obtained 
by a combination of digitalis with quinine and iron. I£ Pulv. digi- 
talis, 3ij ; ferri redacti, quininae sulph., aa 3j. M. Ft. pil. no. xx. 
Sig. : One pill two or three times a day. 

The antipyretic effect of digitalis is a fact much insisted on in 
Germany (Traube, Wunderlich, Thomas, Liebermeister, etc.). In the 



DIGITALIS. 467 

recent elaborate work of Husemann digitalis is classed with the Fie- 
bermittel — the " antipyretica." The results which have followed its 
administration as an antipyretic in fevers (typhoid, typhus, etc.) do 
not, it appears to the author, justify its use in these maladies, notwith- 
standing its power to lower the temperature. Prof. Leyden regards 
it as unsafe as an antipyretic. The indications for its use are, ac- 
cording to Liebermeister, just the opposite of those which obtain in 
cardiac disease ; that is, " digitalis is only to be used in those cases of 
typhoid fever in which there is no considerable degree of cardiac 
weakness." He usually gives from eleven to twenty-two grains, ex- 
tended over a period of about thirty-six hours. 

In scarlet fever the utility of digitalis is very great ; it lowers the 
temperature and maintains the action of the kidneys, thus obviating 
the two principal sources of danger in that disease. Dr. Daniel Lewis, 
of New York, influenced by the author's opinions on this point, system- 
atically used digitalis as the chief remedy in an epidemic of scarlet 
fever in ~New York, and presented the results in a paper submitted to 
the State Medical Society. While the mortality from this disease, for the 
city at large, is 23 per cent, for Dr. Lewis's cases it was less than 11 
per cent. From a teaspoonful to a tablespoonf ul (according to age) of 
the infusion every two, three, or four hours, is a suitable mode of ad- 
ministration. If uraemia occur, the infusion is the proper remedy, con- 
joined, of course, with other means. The author has seen most excel- 
lent results from a poultice of digitalis-leaves, applied to the abdomen 
and back, in cases of urc&mic convulsions, the patient being unable to 
swallow, or the stomach so irritable as to reject all medicines. 

Digitalis has been used with success in erysipelas, but it is by no 
means equal to belladonna in this affection. 

In rheumatic fever the testimony in favor of the use of digitalis is 
certainly very strong. It lowers the temperature, and apparently ma- 
terially shortens the duration of the disease. It may be given in 
powders — two grains every four hours — or a corresponding quantity 
of the infusion. In rheumatism, as in every other affection, very 
prompt effects do not follow the use of digitalis ; a day or two must 
elapse before any marked reduction of temperature takes place, but a 
cessation of the joint-trouble may be looked for in seven to ten days. 
Digitalis is more particularly useful in the cardiac compilations of 
acute rheumatism, when irregular and feeble action of the heart, diffi- 
cult breathing, cyanosis, and general oedema, are present. The follow- 
ing is a prescription of Oppolzer in this condition : 1^ Inf. digitalis, 
|ij; liq. potassii citrat., § jss ; acet. scilhe, f ss. M. Sig. : A table- 
spoonful every four hours. 

Digitalis has recently been much employed in inflammatory affec- 
tions, notably pneumonia. On examination of the reported cases the 
author finds that the defervescence, produced apparently by digitalis 



468 EXCITO-MOTORS. 

from the sixth to the tenth day, occurred at the time when the crisis 
in pneumonia is to be expected, and hence it is difficult, if not impos- 
sible, to estimate the precise share which the remedy had in the results. 
That digitalis has any power to prevent the deposition of fibrinous 
material, to prevent or check the migration of the white corpuscles, or 
to arrest the multiplication of the cellular elements of inflamed parts, 
seems to the author highly improbable. That it may be useful to com- 
bat some of the symptoms — high temperature, isehsemia of the arterial 
system from pulmonary obstruction, and low tension of the vessels — 
may be well admitted. 

There is considerable evidence to show that digitalis is serviceable 
in chronic bronchitis with interstitial pneumonia (fibroid lung), when 
accompanied with difficult breathing, secondary dilatation of the right 
cavities, and general anasarca. It diminishes the cough and expec- 
toration, tones up the weakened and laboring heart, and reduces the 
oedema. That digitalis has any curative power in pulmonary tubercu- 
losis or caseous pneumonia, can hardly be credited, notwithstanding 
the claims which have been put forward. It may be used as an anti- 
pyretic when there is much hectic, but the derangement of the intes- 
tinal canal produced by it is a most serious bar to its employment in 
phthisis. 

Some important results have been obtained by the use of digitalis 
in nervous diseases. The congestive form of hemicrania may not un- 
frequently be permanently relieved by the persistent use of digitaline- 
granules (one sixtieth of a grain bis die). Acute maniacal delirium, 
chronic mania, and delirium tremens, are disorders of the brain in 
which digitalis has proved very useful. The conclusions of Dr. Will- 
iams, of Hay ward's Heath Asylum, are as follow : 

" 1. That digitalis is a valuable sedative in the treatment alike of 
recent and chronic mania, and when these forms of disease are compli- 
cated with general paresis and with epilepsy. 

" 2. That the average dose of the tincture is from 3 ss to 3 j, and 
this quantity may be certainly given with impunity for several days, 
and subsequently — adjusted to the state of the pulse — may be advan- 
tageously used for several months. 

" 3. That the indication by which the use of this drug is regulated 
is the state of the pulse, any marked intermittence requiring its imme- 
diate discontinuance. 

"4. That the weakness of the circulation is no indication against 
its employment ; on the contrary, experience shows that the most en- 
feebled subjects bear its administration as well as the most robust." 

In delirium tremens extraordinary doses of the tincture of digitalis 
have been used with success ( 3 ij — 3 iv), but these large doses are un- 
necessary. This treatment is most useful in the young and robust, 
with marked cerebral hyperemia, according to some ; but, according to 



DIGITALIS. 469 

others, in pale subjects with a tendency to cyanosis, the state of the 
brain being one of anaemia, with effusion and oedema. According to 
the author's observation, the latter indications are the more correct. 
The infusion is doubtless a better preparation than the tincture, and 
of this a tablespoonful may be administered every four hours. 

Some supposed cases of arachnitis have been reported cured by 
digitalis, but grave doubts must exist as to the accuracy of the diag- 
nosis. 

Cases of exophthalmic goitre in young subjects, purely functional 
in character, have been cured by digitalis, and the cardiac irregulari- 
ties, and the dilatation of the cervical vessels, ameliorated in even in- 
curable cases. Digitaline is the form in which to employ this remedy, 
or powdered digitalis may be given in pill, with iron and manganese to 
remove the anaemia. 

Since the anaphrodisiac properties of digitalis were ascertained, it 
has been much used in spermatorrhoea. It is adapted to the same class 
of cases as those in which ergot has been shown to be so beneficial, viz., 
feeble erections, frequent emissions, and cold hands and feet. The au- 
thor has seen better results from the combination of bromide of potas- 
sium and digitalis, in the spermatorrhoea of plethora, than from any 
other remedies : ^ Inf. digitalis, § viij ; potassii bromidi, § j. M. 
Sig. : A tablespoonful morning and night, and, after a week, at night 
only. 

Digitalis is one of the most generally useful remedies in dropsy 
which we possess. It is, of course, specially indicated in the mechanical 
dropsy of valvular lesions. In renal dropsy from acute desquamative 
nephritis (tubal nephritis) " of all drugs, digitalis is of the greatest 
value," and the best form in which to administer it is the infusion. 
Several days usually elapse before very decisive results are achieved, 
but the flow of urine is, then, often enormous. The fact that, contrary 
to what has been heretofore believed, digitalis has a direct action on 
the glomerule of the kidney, is of great interest in this connection. 
The author has seen very favorable results from the use of digitalis 
in granular degeneration of the kidney when dropsy supervened, but 
its use in this disease requires caution in consequence of the fact 
that the elimination of urea and of the chlorides is retarded by this 
agent. 

The so-called Cumulative Effects of Digitalis. — The author agrees 
in opinion with those who hold that digitalis is not a cumulative poison 
in the sense in which this term was formerly used. Doses of digitalis 
frequently repeated, so that the effect of one is added to those before 
given, will certainly produce toxic symptoms. In this sense opium, 
belladonna, strychnine, etc., are cumulative poisons. If full doses of 
digitalis are given at proper intervals, and the effects of one dose are 
permitted to cease before the next is given, no accumulation will take 



470 EXCITO-MOTORS. 

place. Sudden toxic symptoms are developed as follows : "When, after 
the administration of large doses, the pulse is much reduced in the re- 
cumbent posture, on rising, the heart is suddenly found unequal to 
maintaining the circulation in face of the increased resistance in the 
arterioles and against the force of gravity. It must not be forgotten, 
further, that the irritability of the vaso-motor nervous system may be 
destroyed by over-stimulation by digitalis, and lethal effects be pro- 
duced in this way. 

Authorities referred to : 

Ackermann, Prof. Th. Ueber die Wirkungen der Digitalis. Volkmanrfs Sammlung, 
No. 48. 

Boehm, Dr. Rudolph. Ueber die physiologische Wirkung der Digitalis und des Digi- 
talin. Schmidt's Jahrbixcher, vol. cliii, 18*72. 

Briesemann, Dr. C. Schmidts Jahrbixcher, vol. cliii, p. 29. 

Dtbkowsky, W., und Pelikau, Eug. Schmidts Jahrbiicher, vol. cxvi, p. 170. 

Foster, Dr. B. Clinical Medicine: Lectures and Essays, 18 74, p. 92. Digitalis in 
Heart Disease. 

Fothergill, Dr. J. Milner. Prize Essay. British Medical Journal, July and August, 
1871. 

Gourvat, M. Gazette de Paris, July to December, 1871, and January to February, 
1872. 

Hirtz, Dr. Gazette Medicale de Strasbourg, 1862. 

Holland, Sir Henry. Medical Notes and Reflections, American edition. 

Homolle, M. Archives Generates, July, 1861, p. 5. 
' Husemann, Prof. Dr. Th. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 914, et seq. 

Kohler, Dr. H. Ueber den Antagonismns der physiologischen Wirkungen der Saponin 
und Digitalin. Archiv f. exper. Path, und Phar., 1873, p. 138. 

Liebermeister, Prof. Dr. Karl. Ziemssen's Cyclopaedia of the Practice of Medicine, 
vol. i, p. 217. 

Letden, Prof. Dr. Deutsche med. Zeitschrift, No. 23, 18S1. 

Maudsley, Dr. Henry. The Practitioner, January, 1869. 

Schmiedeberg, Prof. Archiv fiir exper. Pathol, und Pharmacol, Band iii, p. 16. 

Taylor, Dr. A. S. On Poisons, third edition, London, p. 796. 

Traube, Prof. Dr. L. Berliner klinische Wochenschrift, No. 17, April, 1870, and No. 
18, May 2, 1870. 

Weil, Dr. A. Schmidts Jahrbiicher, vol. cliv, p. 143. 

Convallaria. — All parts of the plant of Convallaria majalis (lily- 
of-the-valley). (Not official.) 

The Preparations. — It is a remarkable fact that different proper- 
ties are possessed by extracts made from the various parts of the plant. 
An extract made from the root has very powerful emeto-cathartic 
property, while it but little affects the action of the heart. The same 
fact is true, to a less or greater extent, of extracts from the whole 
plant. This emeto-cathartic action is due to the presence of a rather 
acrid resin, and hence for the purpose now intended to be subserved 
by the administration of convallaria the preparation used must be 
freed from this resin. An extract prepared from the flowers and 



CONVALLARIA. 471 

stalks, mixed with a third of their weight of leaves and root, is, ac- 
cording to Langlebert, the best preparation, when deprived of the 
resin. In this shape it is a solid extract, has a shining black color 
and a bitter taste, and is freely soluble in water and alcohol. 

Extractum Convallarice. — Extract of convallaria. Dose, gr. v — 
gr. xv. 

An infusion of the flowers, leaves, and stems is also used. Troitz- 
ky employed several formulas in his trials — from two to four scruples 
of convallaria to four ounces of water. 

Infumm Convallarice. — Infusion of convallaria (convallaria, 50 
parts ; water, 200 parts). Dose, a tablespoonful. Another formula 
is eight ounces of convallaria to a pint of boiling water, which is twice 
the strength of the above. 

As the active principle presents many advantages, this will proba- 
bly be preferred for administration in cardiac affections. 

Composition. — In 1858 Walz announced the presence in tjiis plant 
of two glucosides — convallarin and convallamarin. There are impor- 
tant differences in the qualities of these substances. The former, con- 
vallarin, occurs in colorless, rectangular prisms, is slightly soluble in 
water, but freely so in alcohol. Convallarin, as Marme first ascertained, 
is a purgative in doses of three or four grains (Husemann). It is 
probable that the presence of this giucoside in the resin is the secret 
of the cathartic property of this substance, in part at least. Conval- 
lamarin is not crystallizable, is a white powder, bitter, and freely sol- 
uble in water and alcohol, but not in ether. The dose when admin- 
istered by the stomach will range from one fourth of a grain to two 
grains ; but further investigations are needed to decide this point. 
This is the principle of convallaria, to which its cardiac actions are 
due. It is probable that the perfectly pure alkaloid possesses much 
greater activity than the dose above stated indicates. 

Physiological Actions. — For some time no other powers were 
attributed to convallaria than those of a cathartic intermediate in 
action between scammony and aloes. In Russia it has long been 
known as a remedy for dropsy. This fact finally induced Troitzky 
and Bojojawlensky to study its action more closely, and Prof. Bot- 
kin, of St. Petersburg, subsequently confirmed their researches. 

It was not, however, until Prof. See undertook the study of its 
powers and actions, that general interest was aroused, although Marme 
had, as is stated above, some time before, given an accurate account 
of the physiological actions of convallaria. Since the publication of 
See's observations, the actions of this medicament have been inves- 
tigated by various English and American observers. From these 
sources, and some personal studies, the author makes up the follow- 
ing account : 

Notwithstanding the emeto-cathartic action, if the extract freed 



472 EXCITO-MOTORS. 

from the resin, or convallamarin, the active principle, is given, no dis- 
turbance of the stomach occurs. It stimulates the appetite somewhat, 
and digestion is not impaired. An increase of peristalsis occurs, and 
the evacuations, without being loose, become easy. In warm-blooded 
animals it slows the heart and raises the arterial tension. At the 
same time the respiratory movements are rendered more full and 
somewhat less frequent. These effects are due to stimulation of the 
vagus, but the nerve does not lose its irritability. If the dose be lethal, 
after this first stage, the heart becomes irregular in rhythm, the force 
of the cardiac contractions varies, and the respirations are disturbed, 
inspiration growing deep and prolonged, owing to spasm of the inspir- 
atory group of muscles (See). In the third period of the action, just 
before death, the arterial tension rises very high, but the pulse is ex- 
ceedingly rapid ; then the pressure falls, the respiration growing 
deeper and very slow, and the heart stops in systole, before the breath- 
ing finally ceases. The vagus does not wholly lose its irritability, but 
near the end a strong faradic current does not stop the heart. The 
irritability of the motor and sensory nerves remains unaffected, and 
the muscles preserve their contractility. The pupil is unaffected and 
the functions of the brain are undisturbed. 

The diuretic effect of convallaria is very constant and decided, a 
fact long known in Russia, but no change occurs in the composition 
of the urine. 

Therapy. — In suitable doses — 15 to 25 grains of the extract — con- 
vallaria slows the heart-beats, and often restores the normal rhythm 
of the heart when disturbed, increases the energy of the cardiac con- 
tractions, raises the arterial tension, and at the same time the respira- 
tory movements acquire increased force and volume. These impor- 
tant therapeutical effects are wrought without affecting the functions 
of the brain and spinal cord. It is also a prompt and certain diuretic, 
increasing the discharge of all the urinary constituents. The therapeu- 
tical indications based on these physiological actions are the follow- 
ing : Palpitation, disordered rhythm, or vehement action, dependent on 
impaired function of the pneumogastric, or on hypertrophy of the mus- 
cular walls ; narrowing of the mitral orifice (mitral stenosis) or insuf- 
ficiency of the mitral valves, with stasis in the venous circulation, with 
or without spasmodic breathing ; dilated heart, with or without fatty 
change or sclerosis ; in all cardiac affections accompanied by dropsy 
(See). The signal advantage which it offers over digitalis is the 
absence of danger from its administration, and the freedom of the 
cerebro-spinal axis and the digestive organs from disturbance. It 
has now been used in the maladies above mentioned by numerous 
observers in various parts of the world ; and, although the reports are 
not uniformly favorable, there can be no doubt that we have in con- 
vallaria an important addition to our resources. 



STROPHANTUS. 473 

Authorities referred to : 

Ferrand, Dr. G. Sur leMuguet [convallaria]. Annuaire de Tlierapeutique, Bouchar- 
dat, 1883, p. 135. 

Juk, Dr. London Medical Record, June 15, 1883. 

Langlebert, M. Adolphe. Note sur le Convallaria Mdialis. Bull. Gen. de Therap., 
vol. ciii, p. 74. 

Moutard-Martin, Dr. Sur la valeur de Vextrait de Muguet comme medicament diu~ 
retique. Bouchardafs Annuaire for 1883, p. 132. 

See, Prof. Germain. Recherches expcrimentales sur le Muguet (Convallaria Ma'ialis). 
Bull. Gen. de Tlierapeutique, vol. ciii, p. 49. 

Tanret, C. Ibid., vol. cii. Convallamarine, principe actif de Muguet (Convallaria 
Maialis). 

Troitzky and Bojojawlensky. Wratch 47 and 49. Annuaire de Tlierapeutique, 
1883, p. 127. 

Strophantus. — (The Kombe arrow-poison.) The seeds of Stro- 
phantus hisjridus, of the natural order of Apocynacem. 

Composition and Properties. — The active constituent of stro- 
phantus is a glucoside, to which the name strophantin has been 
given. It is contained in largest proportion in the seeds — from eight 
to ten per cent. This glucoside is very powerful, and hence the native 
uses of it as an arrow-poison. 

Strophantin is crystallizable, slightly acid in reaction, freely solu- 
ble in water and in alcohol, but insoluble in ether, chloroform, and 
benzine. 

Prof. Fraser, of Edinburgh, to whom we are indebted for this 
new remedy, advises a tincture for stomachal administration, and re- 
serves the glucoside for subcutaneous injection. Tinctura strophanti 
[Fraseri) has the strength of 1 to 20 by weight, and the dose will 
range from one minim to ten minims, according to the manner of giv- 
ing it. To maintain a uniform action, the initial dose may be larger, 
and the impression continued by small doses at short intervals. 

Strophantin can be administered in aqueous solution, but long 
keeping will probably affect its quality. The following formula may 
be used : 3 Strophantini, gr. j ; aquae chloroformi, J j. M. Five 
minims of this solution contain about y^-g- gr. The chloroform-water 
is proposed as the solvent, because it will remain sterile. Although a 
minute quantity only of the chloroform is dissolved in water, it proves 
to be sufficient to prevent for a few weeks the development of the 
penicillium, and yet not enough to make the injection painful. The 
dose of the glucoside is t J-q to -^ grain. 

Actions and Uses. — Strophantus is bitter in taste, and, like many 
other bitters, promotes appetite and digestion. It is not irritating to 
the stomach, and apparently does not cause nausea. The property for 
which it is now introduced, however, is the more important one — that 
of cardiac tonic. Strophantus slows the heart-beat, lengthens the in- 



474 EXCITO-MOTORS. 

terval between the contractions, and increases the energy of the cardiac 
muscular tissue. The arterioles are, to some extent, acted upon, and 
contract ; but the rise of the blood-pressure is due more especially to 
the increased power of the cardiac contractions. The action of the 
heart is arrested in the diastole. 

In consequence of the slower movement of the heart and the less- 
ened caliber of the peripheral vessels, the quantity of blood distributed 
in a given time is relatively diminished ; hence the consumption of 
oxygen is smaller, and the activity of the combustion-process corre- 
spondingly depressed. Strophantus is therefore an antipyretic within 
a quite limited range. Some diuretic power is also attributed to it. 

On the foregoing physiological data the therapeutical properties 
are based. It has been prescribed with very distinct good effect in 
cases of mitral disease not compensated. Like digitalis, it lessens the 
ischemia of the arteries, and increases the rate of movement of the 
blood in the veins ; but, unlike digitalis, it does not much affect the 
caliber of the arterioles, and consequently does not so much increase the 
work of the heart by contracting them. If these valuable observations, 
which we owe to Prof. Eraser, be entirely confirmed by future inves- 
tigations, strophantus will largely supersede digitalis in mitral lesions 
with its attendant disturbances. 

Strophantus does not have a cumulative action, it is said ; but 
that must depend on the frequency of administration, for if the doses 
are given at such a rate that the effects of one have not ceased before 
another is administered, clearly some accumulation of power must take 
place. 

Sparteine. — In another part of this work some observations are re- 
corded on the diuretic and other properties of scoparius or broom. 
It will be convenient to consider here the more recent but well-consid- 
ered actions and uses of sparteine. (See Uri^o-Genital Remedies.) 
As a member of that group, of which digitalis has so long been the 
chief, it well deserves attentive consideration. 

History and Properties. — Sparteine was discovered so long ago 
as 1856 by Stenhouse, but it was not until 1883 that it was taken up 
for examination. It is a liquid alkaloid, contains no oxygen, its for- 
mula being C 30 H 26 N 21 , and it has strong basic qualities, combining 
readily with acids to form salts. The sulphate, which is crystal- 
lizable, dissolves freely in water, while the alkaloid itself is entirely 
insoluble. 

The dose of the sulphate of sparteine is from gr. ss to gr. ij. This 
salt crystallizes in rhomboidal plates, and, as it is so readily soluble in 
w r ater, it can be administered subcutaneously or by the stomach, as 
circumstances may require. 

Actions, Physiological and Therapeutical. — The physiological 



SPARTEINE. 475 

actions of sparteine were first studied by Mills in 1863, and by Fick 
in 1870, afterward by Rymon in Vulpian's laboratory, by Laborde 
and Legris, by GluzinsM and others, and its therapeutical applications 
have been illustrated by Voigt in Nothnagel's clinic, and by Prof. 
See. From these various sources, and from his personal investigations, 
the author has formulated his conceptions of the real place which spar- 
teine should occupy as a remedy. 

The salts of sparteine are bitter, but not irritating to the stomach, 
and apparently have the tonic action, the power to improve appetite 
and digestion, common to the bitters. Unlike digitalis, sparteine acts 
within an hour or two (Laborde, Yoigt) after it is taken, the charac- 
teristic impression on the heart being made. It more truly deserves 
the title of "heart-tonic" than any other remedy. Irregularity in 
rhythm, inequality in the force of the contractions, are almost imme- 
diately corrected, and the action is lasting as well as thorough. It is 
especially in derangement of the motor apparatus of the heart, with 
weakness and irregularity of the pulse, that sparteine affords relief in 
an hour or two, when digitalis would require a day or two to accom- 
plish the same result. So small a dose as one half a grain, as a rule, 
brings about the result above described, and the effect persists twelve 
to twenty-four hours, although a single dose had been given. The 
special conditions in which it is most useful are weakness of the right 
heart and incompetence of its valves, and in lesions and functional de- 
rangement of the mitral (see Yoigt and others). That the curative 
results obtained by the use of sparteine are not hampered by gastric 
disorder is another proof of its superiority to digitalis. 

If digitalis is to be administered in cases of mitral disease and 
prompt action is necessary, sparteine performs a valuable function, 
for if at once given the heart is relieved, and the relief continues until 
digitalis has had time to act. Laborde and Legris, Rymon, Gluzinski, 
and others from the experimental standpoint, and Vulpian, Huchard, 
Voigt, and others from the clinical, conclude that sparteine is the first 
of the remedies now available as a " heart-tonic," and as a regulator 
of the cardiac rhythm when disordered m function merely, and when 
due to lesions of the heart-muscle or valves. 

Sparteine has no " cumulative action " in the sense in which that 
phrase is applied to digitalis. In summing up their observations La- 
borde and Legris assert that in all cases of weak heart with asthenia, 
whether or not organic lesions exist, sparteine is the appropriate 
remedy, and they do not know of any proper contra-indications, as it 
agrees well with the stomach, and has no injurious effect on the cere- 
brospinal nerves. 

Adoilidin. — The active principle — a glucoside — of Adonis vemalis z 
a member of the JRanunciilacece. 



476 EXCITO-MOTORS. 

Peopeettes. — Adonidin is an amorphous substance, without odor, 
colorless, and intensely bitter. It is soluble to a very trivial extent 
in water, but is freely soluble in alcohol. The dose of adonidin is one 
eighth to one half grain, and the best form for administration is the 
compressed pellet or granule. 

The first study of adonidin was made by Bubnow in Prof. Botkin's 
laboratory ; but he failed to isolate the active principle, which was 
subsequently accomplished by Cervello, of Strasburg. 

Actions and Uses. — Although there are differences of opinion on 
this point, it is probable that adonidin, in many subjects, causes nau- 
sea, vomiting, and diarrhoea (Leyden). The chief function for which 
it has been used in medicine is as a substitute for digitalis. It slows 
the heart, lengthens the interval between the beats, and raises the 
general vascular tension by contracting the arterioles. It has also con- 
siderable diuretic power, increasing the flow of water and of solids 
(Lublinski). 

Adonidin acts more quickly and also more powerfully than digi- 
talis, and, in some instances, it has seemed to have more curative 
power. To begin the action before digitalis has had time to act, to 
supply its place in cases of idiosyncrasy, and to form combinations 
when the action of each is supplemented, are the various conditions 
which justify the use of adonidin. 

Authorities for strophantus, sparteine, and adonidin : 

Altmann, Dr. Semaine Med. Abstract in Annuaire de Therap. for 1885. (Substi- 
tutes for digitalis.) ^ 

Bubnow, Dr. Adonidin. Abstract in Centralblatt fur die gesammte Tlierapie for 
1885. 

Certello, V. Dr. Archiv fur experimentette Pathologie und Pharmacologic, vol. xv. 

Durand, Dr. These de Paris, 1886. (On Adonidin.) Annuaire de Therapeutique 
for 1886. 

Fraser, Prop. Thomas R. Tlie British Med. Journal, January 22, 1887. (Stro- 
phantus.) 

Gluziniski, Dr. (Sparteine.) Note in Lancet of February 19, 1887. 

Laborde et Legris, Drs. Archives de Physiol. Kormale et Pathologique, May, 18S6. 
(Sparteine.) 

Leyden, Prof. Dr. Annuaire de Tlierap., 1886. (Sparteine, etc.) 

Lublinski, Dr. Ibid. 

See, Prof. Dr. Bull. Gen. de Therap. Various numbers for 1885, 1886, and 1887. 

Cimicifuga. — Black snake-root. The rhizoma and rootlets of Cimi- 
cifuga racemosa Elliott (Nat. Ord. JRanunculacece). 

Extractum Cimicifugce Fluidum. — Fluid extract of cimicifuga. 
Dose, 3 ss — 3 ij. 

Tinctura Cimicifugce. — Tincture of cimicifuga. Dose, 3 ss — 3 ij. 

Composition. — When fresh, the root contains a volatile oil, which 
possesses in a high degree the characteristic odor of the drug. 
A true active principle has not yet been isolated, yet Conard has 



CIMICIFUGA. 477 

obtained a neutral substance, crystallizable, and having a very acrid 
taste. The so-called cimieifugin is nothing more than an impure 
resin, obtained by precipitation from the tincture by the addition of 
water. The root contains resin, coloring matters, tannic and gallic 
acids. 

Antagonists and Incompatibles. — As the preparations of cimici- 
fuga contain tannic and gallic acids, they are incompatible with the 
salts of iron. Stimulants, as alcohol, ammonia, antagonize cimicifuga 
therapeutically. 

Synergists. — In its action, although feeble, cimicifuga lies between 
digitalis and ergot. Its physiological effects are increased by cold, 
digitalis, ergot, belladonna, etc. 

Physiological Actions. — The taste of cimicifuga is bitter and 
astringent, with an after acrid feeling. In small doses, without pro- 
ducing any sensible physiological effect, it promotes the appetite and 
digestion. In full doses it increases the gastro-intestinal secretions. 
On the heart and circulatory system, cimicifuga has an action not un- 
like digitalis, but less powerful : it slows the heart-beats but increases 
their force, and elevates the tension of the arterial system. Its effects 
on the nervous system, when administered in large doses, are very de- 
cided. It causes vertigo, dilated pupils, and in many subjects consid- 
erable soporific and anodyne effects. There is little doubt that it 
increases the contractility of unstriped muscular fiber in a manner 
that resembles ergot, but much less energetically. It stimulates the 
venereal appetite in man, and promotes the menstrual flow in women. 
Diaphoresis and increased bronchial secretion are produced by it, and 
the urine possesses a distinct odor of the drug. 

In order to procure physiological effects from cimicifuga, it is 
essential that preparations made from the fresh root be employed. 

Therapy. — Cimicifuga is an excellent stomachic tonic, and is espe- 
cially adapted to the treatment of the irritative dyspepsia of drunk- 
ards. In fevers and inflammatory disorders, when the action of the 
heart is quick and the tension of the vessels low, cimicifuga may 
take the place of digitalis, but it is much less efficient than the lat- 
ter. It is an excellent expectorant, useful in bronchitis and in neuro- 
pathic pulmonary disorders. t> Ext. cimicifugse, fl. § ss ; tinct. opii 
deod., 3 j ; syrup, tolu., 3 xj. M. Sig. : A teaspoonful every four 
hours. This combination is efficacious in acute catarrh (common cold), 
and in acute bronchitis after the more active symptoms have subsided. 
Good results have been obtained from cimicifuga in phthisis. It 
would be idle to claim that it is curative ; but, to moderate hectic, to 
improve the appetite, and to facilitate expectoration, it is undeniably 
of service. It is in that form of phthisis now called caseous pneumo- 
nia that cimicifuga can be expected to relieve symptoms, and not in 
tuberculosis. 



478 EXCITO-MOTORS. 

Dilated heart, fatty heart, languid circulation, oppressed breath- 
ing, general dropsy, are conditions in which cimicifuga takes the 
role of digitalis, and although less efficient, is safer, especially in the 
case of fatty heart. 

Most favorable reports have been made of cimicifuga in acute rheu- 
matism. Chronic rheumatism, with tumefaction of the joints, lum- 
bago, intercostal pain, and myalgia, are disorders affecting the mus- 
cular system, in which this drug sometimes succeeds in a wonderful 
manner ; yet it very often fails, and we are, unfortunately, unable to 
indicate beforehand the particular kind of cases in which it is most 
beneficial. 

The power of cimicifuga to relieve certain kinds of pain is well 
established. Neuralgia of the fifth, arising from cold, rheumatic head- 
ache, ovarian neuralgia, succeeding to suppressed or arrested menstru- 
ation, etc., are forms of pain in which this remedy is frequently very 
effective. 

Puerperal mania, hypochondriasis, and convidsions, due to men- 
strual irregularities, have been cured by cimicifuga. The greatest 
successes of this drug have been achieved in chorea. It is useful in 
those cases which arise about the period of puberty, and are connected 
with disorders or perversions of the menstrual flow. 

Cimicifuga relieves the pains of dysmenorrhea when of the con- 
gestive variety. Heat of head, flushings of the face, pain in the head, 
bach, and limbs, quick pulse, and nervousness, when due to arrest of 
the monthly flow, are often remarkably benefited by this agent. It has 
been used to promote parturient pains, to induce uterine contractions 
after delivery, and to relieve after-pains, but it is inferior to ergot for 
most of these purposes. It is serviceable in subinvolution of the uterus, 
and may be given in combination with ergot. 

The aphrodisiac effects of cimicifuga render it useful in sperma- 
torrhoea. It is not adapted to physiological spermatorrhoea, which is 
really a condition of normal plethora, but to those cases in which the 
organs are relaxed, the erections weak, and the seminal discharges 
feeble and occur on slight excitement. 

To obtain curative effects from cimicifuga, it must be adminis- 
tered in sufficiently large doses to produce some of its cerebral 
or other physiological actions. 

Authorities referred to : 

Davis, Dr. N. S. Transactions of the American Medical Association, i. 352. 
Hildreth, Dr. American Journal of Medical Sciences, October, 1842. 
Phillips, Dr. Charles D. F. Materia Medica and Therapeutics, London, 1874, 
p. 39. 

Porcher, Dr. Francis P. Resources of the Southern Fields and Forests, p. 18. 
Ringer, Dr. Sydney. Handbook of Therapeutics, article Aetata. 
Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii, p. 562. 



BELLADONNA. 479 

Belladonna. — Deadly nightshade. 

Belladonnce Folice. — Belladonna - leaves. The leaves of Atropa 
belladonna Linne (Nat. Ord. /Sola?iacece), U. S. P. Feuilles de bella- 
done, Fr.; Tollkraut, Ger. 

Belladonnce Radix.— Belladonna-root. The root of Atropa bella- 
do?ina, as above. Racine de belladone, Fr.; Belladonnawurzel, Ger. 

Abstr actum Belladonnce. — Abstract of belladonna. Dose, gr. ss — 
gr. j. Prepared from the root. 

Fmplastrum Belladonnce. — Belladonna-plaster. (Belladonna-root 
and resin -plaster.) 

Fxtractum Belladonnce. — Extract of belladonna. Dose, gr. i— gr. j. 

Fxtractum Belladonna} Alcoholicum. — Alcoholic extract of bella- 
donna. Dose, gr. \ — gr. j. Prepared from the leaves. 

Extractum Belladonnce Fluidum. — Fluid extract of belladonna. 
Dose, TTi j — ttl v. Prepared from the root. 

Tinctura Belladonnce. — Tincture of belladonna. Prepared from 
the leaves. Dose, ttl v — 3 ss. 

Composition. — Belladonna contains a peculiar alkaloid, atropine, 
on the presence of which the physiological activity of the drug de- 
pends. This principle is found chiefly in the bark of the root, and of 
young root. Another principle has also been discovered analogous to 
atropine, to which the name belladonnine has been given. Ladenburg 
has shown that belladonnine is identical with the active principle of 
hyoscyamus, or hyoscyamine. It is identical with atropine in compo- 
sition, and can only differ in the arrangement of its molecules. The 
root also contains a fluorescent substance and a coloring matter, which 
has been called atrosin. Atropine exists in the plant in combination 
with malic acid as bimalate. 

Atropina. — Atropine. Is in yellowish-white, silky, prismatic crys- 
tals, without smell, but having a bitter and acrid taste. It is soluble 
in three hundred parts of water at 60° Fahr., in twenty-five parts of 
ether, and in much less alcohol. It has a strong alkaline reaction, and 
forms crystallizable salts with acids. 

Atropince Sulphas. — Sulphate of atropine. Is a white, crystal- 
line powder, very soluble in water and in alcohol. Dose, gr. y^ — 

gr. eV 

Atropince Salicylas, Atropince Hydrobromas. — The salicylate and 
hydrobromate, especially the former, are preferred to the sulphate by 
many ophthalmologists. 

Antagonists and Incompatibles. — Caustic alkalies act on atro- 
pine, and ammonia is evolved ; they are, therefore, incompatible with 
the preparations of belladonna. As respects physiological antagonism, 
pilocarpus and physostigma counterbalance the actions of belladonna 
in almost the whole range of its influence, and opium — within certain 



480 EXCITO-MOTORS. 

limitations to be hereinafter described — prevents the respiratory fail- 
ure, the cause of death. 

Physiological Actions. — Dryness of the mucous membrane of 
the nose, mouth, throat, and larynx, is produced by the direct appli- 
cation of atropine to these parts, and the same effects in a more 
positive manner follow the stomach or subcutaneous administration. 
A peculiar bluish appearance of the lips, as well as dryness, the 
author has frequently observed. Nausea is occasionally produced 
by belladonna, but this effect is probably due to cerebral disturb- 
ance. Dryness of the mucous membrane of the stomach and intes- 
tines is doubtless produced by belladonna, but increased secretion 
occurs subsequently, for the stools are rendered more liquid, and are 
also voided more frequently. Increased peristalsis is most probably a 
result of the action of belladonna on the unstriped muscular fiber of 
the intestines. 

The active principle of belladonna (atropine) is an extremely dif- 
fusible substance. What changes it induces in the blood, if any, are 
not known. It affects the circulation in a remarkable manner. In 
some subjects a decided slowing of the heart takes place immedi- 
ately after the administration of a considerable dose (atropine hy- 
podermatically) and in all, most probably, an instantaneous retarda- 
tion of the pulse-rate, but a very decided rise in the number of pul- 
sations quickly follows. Not only is the number of the heart-beats 
increased, but their vigor also, and the area over which the pulsa- 
tions are distributed is enlarged. It has been conclusively shown 
that the increased action of the heart is due, first, to stimulation of 
the cardiac ganglia of the sympathetic, and, secondly, to a paralyzing 
action on the pneumogastric terminal filaments. In other words, the 
motor power of the heart is increased in activity, and the inhibiting 
control is lessened. 

The stimulation of the vaso-motor centers by belladonna, or atro- 
pine, causes a general rise of blood-pressure owing to contraction of 
the arterioles. This action of atropine rapidly produces a state of 
over-excitation, and the irritability of the vaso-motor nervous system, 
at first increased, soon diminishes ; the action of the heart becomes 
weak, the vessels dilate, and the blood-pressure falls below the normal. 
In large medicinal doses this effect is easily seen, and, in lethal doses 
in animals, it may be most certainly demonstrated. 

As regards the function of respiration, atropine increases the num- 
ber and depth of the respiratory movements, but the increase is not in 
the same ratio as is the elevation of the pulse-beat. The more rapid 
action of the heart, the increased respiratory movements, the contrac- 
tion of the arterioles, result in an increased supply of blood to the 
periphery, more rapid nutritive changes, and consequent elevation of 
temperature. The rise in temperature in man, from a full medicinal 



BELLADONNA. 481 

dose, is from -J to 1° Fahr. This increased body-heat is not long 
maintained ; with the fall in the blood-pressure (vaso-motor paresis), 
there ensues a diminution in temperature. 

In persons of a light complexion, more especially in women, a full 
dose of atropine is frequently followed by a diffused redness of the 
skin, not unlike the rash of scarlatina, but wanting in the punctated 
character of this specific eruption. Redness of the fauces, and some 
difficulty of swallowing, owing to the dryness of the mucous mem- 
brane, occur at the same time, rendering the similitude to scarlet fever 
very striking. The flush of atropine succeeds to a marked but tem- 
porary pallor, which is the first effect, and is a symptom of the vaso- 
motor paresis which succeeds to the vaso-motor stimulation. The bel- 
ladonna rash is sometimes followed by desquamation. 

Dilatation of the pupil is a conspicuous effect of atropine. Whether 
dropped into the eye, introduced into the stomach, or injected under the 
skin, prompt and decided dilatation of the pupil follows. A much 
smaller quantity suffices to produce this effect, when applied directly 
to the eye. Paresis of the muscle of accommodation is caused by 
atropine, and this agent also lessens the intraocular pressure. It has 
been conclusively shown that atropine produces these remarkable 
effects by an action on the peripheral filaments of the nerves of the 
iris, and not on its muscular fibers ; atropine paralyzes the oculo-motor 
nerve end-organs, and stimulates those of the sympathetic. 

The cerebral effects of belladonna are very characteristic. Head- 
ache, vertigo, illusions, hallucinations, a busy delirium, sometimes 
somnolence, are produced by large doses. The vision is usually lost, 
the pupils are dilated to the utmost, the eyes are brilliant and staring. 
Muscular weakness, inco-ordination, and complete motor paralysis oc- 
cur ; but sensation is not destroyed ; although occupied with fancies 
and illusions, the patient may be indifferent to moderate irritation. 
The delirium which occurs has a peculiar character : it may be gay 
and laughing, or busy, the patient being incessantly occupied with a 
single object or idea ; or it may be noisy and furious, the patient fight- 
ing and striking all who approach. In lethal doses convulsions may 
occur, or profound stupor may result after a period of delirious excite- 
ment. 

The voluntary muscles are not affected by belladonna. The mus- 
cular paresis which results from the administration of this drug is due 
to its action on the motor nerves, but the excitability of these nerves 
is diminished only, and not wholly destroyed. Both the motor-nerve 
trunks and the end-organs are affected. The sensibility of the sensory 
nerves is also impaired, but is not diminished to the same extent as is 
that of the motor nerves. 

Although the action of belladonna is so largely paralyzant, it is 
not exclusively so, and, under certain circumstances, a tetanic action 
32 



4S2 EXCITO-MOTORS. 

very similar to that caused by strychnine is developed. In frogs, a 
day or two after the induction of paralysis by the subcutaneous 
injection of atropine, the tetanic state occurs. When this state is 
reached, although the frog lies perfectly limp and motionless if un- 
disturbed, an irritation applied to the periphery will at once cause 
general tetanic rigidity and spasms. The author was the first to 
show that this condition of the nervous system is attained in frogs 
an hour or two after the conjoined administration of atropine and 
physostigma (eserine). 

Atropine, by virtue of the greater than normal transmission of 
blood through the tissues, increases metamorphosis, and the results 
of this are represented in an increased elimination of the products 
of waste. 

Atropine is eliminated chiefly by the urine, and the urine of an 
atropinized animal will dilate the pupil of another animal. 

Therapy. — In mercurial ptyalism, and the ptyalism of the preg- 
nant state, a few drops (five to ten) of the tincture of belladonna, 
given every four to six hours, or a corresponding quantity of atropine, 
will cause the excessive secretion to diminish, and even dry up, and 
will thus relieve a very disagreeable symptom. Gastralgia, as well as 
the pain w r hich accompanies gastric ulcer, is often happily relieved by 
atropine. $ Atropinae sulphatis, gr. j ; zinci sulphatis, 3 ss ; aquae 
destil., | j. M. Sig. : From three to five drops twice or thrice a day. 
A similar combination is very effective in pyrosis, chronic gastric ca- 
tarrh, and irritative dyspepsia. Atropine is frequently effective in 
relieving the vomiting of pregnancy. I> Atropine sulphat., gr. ij ; 
aquae destil., f j. M. Sig. : Two drops in water before meals. It is 
often more useful when applied to the rectum in the form of supposi- 
tory. It sometimes gives great relief when applied to the epigastrium 
in chloroformic solution. Ijfc Atropine, gr. v ; chloroformi, f j. M. 
Sig. : A piece of lint to be moistened with the solution and laid on the 
epigastrium. 

The extract of belladonna is a useful addition to purgatives, to di- 
minish the harshness and at the same time to increase the effectiveness 
of their operation. Belladonna has the power to increase the peristal- 
tic movements and to allay irregular or spasmodic movements. It is, 
therefore, used to overcome habitual constipation. A pill containing 
a half -grain of extract, taken at night, will sometimes succeed, but it 
is generally better to combine it as follows : r> Ext. belladonnas, ext. 
nucis vomicae, ext. physostigmatis, aa gr. iij. M. Ft. pil. no. vj. Sig. : 
One at bed-hour. An addition of a half -grain of aloin will, of course, 
increase the action of this pill, and may be added when there are great 
torpor and inaction of the intestines. 

When, in affections of the gastro-intestinal apparatus, acids are in- 
dicated with atropine, they may be combined as follows : £> Acid. 



BELLADONNA. 483 

muriat. dil., f j ; atropine, gr. ss. M. Sig. : Five drops in water 
before meals. Such a prescription is useful in heart-burn, water- 
brash, etc. 

Harley advises the use of atropine as a cardiac stimulant ; but the 
fact that this agent exhausts the irritability of the cardiac ganglia 
after a period of excitement requires discrimination in its use. Not- 
withstanding this objection, atropine may be given to counteract a 
sudden and temporary depression in the heart's action — as, for exam- 
ple, in the collapse of cholera, in which it has been employed success- 
fully by the hypodermatic method. 

Belladonna is a remedy of great efficacy in certain acute inflamma- 
tions of the air-passages. No remedy gives such prompt and sustained 
relief in acute nasal catarrh with profuse watery secretion. To adults, 
the best method of administration consists in giving a first dose of five 
drops of the tincture, and repeating a drop or two drops every hour 
until atropinism is produced. This remedy is also very admirably 
adapted to the treatment of ordinary sore-throat. As a constant phys- 
iological action of belladonna is redness and dryness of the fauces, its 
therapeutical action, in sore-throat with increased secretion, is anti- 
pathic or substitutive ; or, as it may be more scientifically expressed, 
the action of belladonna is the physiological antagonist of the disease- 
action, ^hen there is much fever it is useful to combine aconite with 
belladonna, rjk Tinct. aconiti rad., 3 j ; tinct. belladonna, 3 ij. M. 
Sig. : Four drops in water every hour or tioo. That form of aphonia 
which is due to fatigue of the vocal cords may be removed very speed- 
ily by a morning and evening dose ( T J-g- — fo of a grain) of atropine. 
Not unfrequently hysterical aphonia may be quickly cured in the 
same way. 

There is much to be expected from the use of belladonna prepara- 
tions in whooping-cough. The best form for administration is a solu- 
tion of the sulphate of atropine (gr. j — § j of water. Dose, Tij, ij — 
HI iv). This remedy is not adapted to all cases, and is most effective in 
the spasmodic stage. In order to be curative, physiological effects 
must be produced. The good results of atropine in whooping-cough 
are most obvious in those cases characterized by profuse bronchial 
secretion. 

Belladonna gives great relief in paroxysms of asthma, and in the 
spasmodic difficulty of breathing which accompanies emphysema. Ac- 
cording to the author's observation, when the bronchial mucous mem- 
brane is deficient in secretion, the pulse much accelerated, the skin dry 
and hot, belladonna rather adds to the distress ; and its good effects 
are most conspicuous when there are abundant expectoration, a cool 
and moist skin, and a quiet pulse of low tension. In asthma, atropine 
may be injected subcutaneously, or the belladonna-leaves be used by 
the method of fumigation. Belladonna-leaves, dipped in a saturated 



484 EXCITO-MOTORS. 

solution of niter and then dried, may be burned in a close apartment, 
the patient breathing the fumes until relief is obtained. Pastiles are 
made of belladonna, stramonium, poppy, tobacco, etc. A good for- 
mula for cigarettes is the following (Trousseau) : Belladonna, grs. v ; 
stramonium and hyoscyamus, of each grs. iij ; extract of opium, ^ of 
a grain ; cherry-laurel water, a sufficient quantity. The leaves are 
moistened with a solution of the opium in the cherry-laurel water, and 
when dry made into a cigarette. Two to four of such cigarettes may 
be smoked daily. When the paroxysms of asthma occur in the morn- 
ing, they may sometimes be prevented by the one sixtieth of a grain 
of atropine at bedtime. 

The remarkable similarity in the symptoms of atropinism and of 
scarlatina has led to the use, by homoeopathic practitioners, of bella- 
donna as a prophylactic against this disease. The points of resem- 
blance are so superficial, and the differences so wide, that no more 
striking instance could be adduced of the uncertainty in the applica- 
tion of the homoeopathic dogma, even admitting its truth. The au- 
thor is convinced that the so-called prophylactic power of belladonna 
against scarlatina has no real existence. He has seen too many cases 
of scarlatina occur in subjects who had been given the remedy freely, 
to permit him to come to any other conclusion. Belladonna is a use- 
ful remedy to relieve some of the symptoms in scarlatina. During 
the stage of eruption it is indicated when the pulse is feeble, the bod- 
ily powers are depressed, and the rash is imperfectly evolved. In this 

condition of things — in which carbonate of ammonia is so much used 

belladonna also renders most important service ; but it should not be 
forgotten that these agents are chemically incompatible, and should 
not, therefore, be prescribed together. 

In diphtheria, when there is much depression, belladonna is a most 
excellent remedy. If given before the exudation has spread and con- 
solidated into membranous plaques, and when a few patches only have 
appeared on the tonsils, or soft-palate, it seems to have the power to 
hinder tlie formation of the exudation. 

There is no doubt that belladonna has a real curative power in 
erysipelas. It is especially adapted to idiopathic erysipelas, notably 
to facial erysipelas, and is less serviceable in traumatic erysipelas. 
Homceopathists explain this on the doctrine of similars, but the action 
is really one of antagonism, or substitution. When there is much 
fever, digitalis or aconite may be combined with belladonna with ad- 
vantage, and when there is much depression, quinine. ^ Quininse 
sulph., 3 ss ; belladonnas extract., grs. iij . M. Ft. pil. no. x. Sig. : 
One every four or six hours. 

Excellent results have been obtained from the use of belladonna in 
typjhus and typhoid fevers. 'Graves originally suggested an indication 
for its use in fevers, which is doubtless serviceable, viz., contracted 



BELLADONNA. 485 

pupils ; but belladonna has been used, irrespective of this sign, by- 
other practitioners with great success. The tincture is a suitable 
preparation, and of this from five to ten drops every four hours is a 
proper dose. According to the author's observation, belladonna is in- 
dicated when there is much low, muttering delirium, subsultus, and 
stupor, and is contraindicated in the condition of delirium ferox. 

Belladonna has important application in the treatment of certain 
disorders of the nervous system. Sick-headache, due to or accom- 
panied by spasm of the arterioles — a condition manifested by pallor 
of the face, vertigo, and tinnitus aurium — is relieved by belladonna. 
At first the distress may be even increased, but great relief presently 
follows. This remedy is injurious in the congestive form of sick- 
headache. The following is a serviceable combination in the cases of 
sick-headache due to vaso-motor spasm : Ijfc Atropine sulph., gr. ss ; 
chinoidin, 3 j. M. Ft. pil. no. lx. -Sig. : One pill twice or thrice a 
day. 

Although belladonna in the physiological state induces wakeful- 
ness and busy delirium, in certain morbid states of the brain it is hyp- 
notic. The indications for its use are as follows : prostration, low 
state of the arterial tension, languid intra-cranial circulation, a con- 
tracted pupil, and insomnia, due to the condition of the brain mani- 
fested by these objective signs. In various kinds of mental disorder, 
in which the foregoing symptoms are present, much good may be ex- 
pected from the use of belladonna in moderate doses ; but harm only 
will be produced by it when there is much vascular excitement. 

Belladonna, according to Trousseau and Pidoux, is a more efficient 
remedy in the treatment of epilepsy than the salts of silver, copper, or 
zinc. They insist that the capital condition of success is perseverance 
on the part of the physician and patient, that belladonna should be 
given steadily for a year in gradually-increasing doses, and that if 
amendment is then produced it should be continued through two, 
three, or even four years. Belladonna is not equal to bromide of 
potassium in cases of diurnal epilepsy, in epilepsy accompanied by 
cerebral hyperemia, and in epileptiform convulsions due to coarse or- 
ganic lesion of the brain. The best results are obtained from it in 
nocturnal epilepsy, in petit mal, and in pale, delicate, and anaemic sub- 
jects, with cold hands and feet, blue skin, and weak heart. 

In neuralgia belladonna affords relief, although not equal to some 
other agents. Given hypodermatically {see post), it is often very effec- 
tive. In any case, its use must be persisted in ; full doses are neces- 
sary, and physiological effects must be produced and maintained for 
some time. A solution of atropine is the best form for the stomach 
administration. Dysmenorrhoea, when neuralgic in character, and 
ovarian neuralgia, may be permanently removed by belladonna. It 
is useful in these cases to combine it with synergistic remedies. r> 



486 • EXCITO-MOTORS. 

Ext. belladonna, grs. iv ; ext. stramonii, grs. v ; ext. hyoscyami, grs. 
v; quininge sulphat., 3ij. M. Ft.pil.no. xx. Sig. : One pill two or 
three times a day. When anaemia exists, iron may be added to this 
formula. 

No single agent has been as uniformly successful in the treatment 
of nocturnal incontinence' of urine as belladonna. This morbid state 
is due to several conditions, and belladonna is not equally successful 
in all : nocturnal incontinence may be due to an excess in the acidity 
of the urine, which renders it unduly stimulating ; to relaxation of. 
the sphincter vesicae ; to an irritability of the mucous membrane, in 
consequence of which erroneous impressions are communicated to the 
brain. Belladonna gives relief in the two last-named conditions. The 
atropine dissolved in the urine acts locally on the nerves of the mucous 
membrane, diminishing their irritability ; the sphincter is put into a 
state of tonic contraction by reason of the systemic effect, which 
includes, of course, the sympathetic system. The error is often com- 
mitted of giving too little of the remedy ; systemic effects must be 
produced, and children, compared with adults, are insusceptible to 
the action of belladonna. The best form for administration, be- 
cause less disagreeable and more constant in effect, is a solution of 
atropine. 

Nocturnal seminal losses, as respects mechanism of production, 
making allowance, of course, for difference of seat, have a strong 
analogy with nocturnal incontinence of urine. This trouble may be 
considered a morbid state, only, when the losses are frequent and affect 
the health. Bromide of potassium best relieves sperm at orrh 02a, so 
called, when it is largely physiological and due to a normal plethora ; 
belladonna is most serviceable when the genitalia are relaxed, the 
emissions flowing without force, and without a distinct dream and 
orgasm. 

Atropine is a remedy of the greatest importance in the practice of 
ophthalmology. As it dilates the pupil, diminishes the intraocular 
pressure, contracts the arterioles, and acts topically on the sentient 
nerves, it is obvious that its field of utility is wide, and its therapeutic 
power great. 

In phlyctenular keratitis atropine renders the greatest service ; it 
diminishes the photophobia and blepharospasm, and lessens the blood- 
supply by contracting the vessels. It has a still more beneficial action 
in iritis / it prevents adhesions, anterior and posterior, and by dilata- 
tion of the pupil so compresses the vessels as to jugulate the inflam- 
matory process. When the cornea is perforated, herniary protrusion 
and adhesion of the iris are prevented by dilating the pupil. For these 
purposes a four-grain solution of atropine is the proper strength for in- 
stillation into the eye. When it is desirable to suspend the power of 
accommodation, in cases of hypermetropia to determine the refraction 



BELLADONNA. 487 

of the eye, and in astigmatism to ascertain the difference in the me- 
ridians, atropine is used. A weak solution only is employed, to dilate 
the pupil for a brief period, in order to facilitate the examination of 
the fundus of the eye. Dilatation of the pupil with atropine is also 
necessary in the examination of cataract, especially in the early stages 
of its formation. It should be remembered that strong solutions of 
atropine instilled into the eyes may, by subsequent absorption, pro- 
duce atropinism, and to such an extent as to occasion solicitude. 

In certain affections of the skin belladonna is useful — viz., in the 
cutaneous neuroses, prurigo, herpes zoster, erythema, and eczema, etc. 
Cases of these affections which resist ordinary treatment, yield to bella- 
donna. The tincture, or the alkaloid, in suitable doses, may be given 
in quantity sufficient to maintain a slight physiological action. Hyper- 
idrosis (colliquative sweating), unilateral sweating, and other forms 
of profuse transpiration through the skin, are arrested by the internal 
and, in some cases, by the local application of the belladonna prepara- 
tions, as Ringer has shown. 

No remedy is so generally effective in relieving the sioeats of 
phthisis as atropine. The one sixtieth of a grain at bedtime usually 
suffices. The author was the first to indicate this use of atropine in his 
"Prize Essay." Not only is atropine antagonistic in action to that 
condition of the sudoriparous glands resulting in the sweats of disease, 
but it equally antagonizes the hyperidrosis produced by such drugs as 
jaborandi. 

In the treatment of that form of phthisis known as caseous pneu- 
monia, atropine has an important place, quite irrespective of its power 
to arrest the sweats. As Dr. Fothergill, of London, and myself, nearly 
simultaneously ascertained, it has an influence on the progress of these 
cases, and a curative effect that is often very remarkable. The author 
has observed with regret that some of those who have found this rem- 
edy useless, were entirely mistaken as to the character of the cases in 
which atropine has proved beneficial. As a remedy for the caseous 
inflammation, without regard to sweating, the period when the degree 
of benefit above referred to may be expected from it, is the stage of 
deposit immediately succeeding the stage of catarrhal inflammation, 
and before softening and extrusion, and not in tuberculosis. 

Hypodermatic Use of Atropine. — The solution usually employed 
for this purpose is two grains of the sulphate of atropine to an ounce 
of distilled water, the dose of which ranges from one to five minims. 

There are two forms of neuralgia in which the subcutaneous use 
of atropine has been most signally useful : tic-douloureux and sciatica, 
more especially the latter. Atropine is not as effective in the treat- 
ment of the neuralgias in general as morphine, and the systemic effects 
of the former are much more unpleasant than those caused by the lat- 
ter. Nevertheless, when morphine fails or disagrees with the patient, 



488 EXCITO-MOTORS. 

atropine may be used with confident expectation of its affording re- 
lief. We owe to Hunter our knowledge of the fact that atropine has 
a very special utility in tic- douloureux and sciatica. The merely sub- 
cutaneous injection of atropine does not afford the same degree of 
relief as its deep injection in the neighborhood of the affected nerve- 
trunk. Furthermore, a decided impression must be made on the cere- 
brum, in order to obtain the best results. The largest doses compati- 
ble with the safety of the patient must be used — generally the one 
fiftieth of a grain to the one thirtieth. If the remedy is employed in 
sufficient quantity, and well inserted into the tissues above the nerve, 
decided curative results may be expected from it in these two forms 
of neuralgia. When relief follows the injection of atropine, it is apt 
to be more permanent than when the same degree of relief is obtained 
from morphine. We have the high authority of Dr. Anstie for the 
assertion that atropine is exceptionally serviceable in peri-uterine and 
dysmenorrhceal neuralgia. Dr. Weir Mitchell asserts that atropine 
in traumatic neuralgias is " simply useless," and, as his power of ac- 
curate observation is unquestioned, and his clinical opportunities vast, 
we may accept this conclusion as final. 

Muscular cramp, from injuries to the nerve-trunk, are often remark- 
ably relieved by injections of atropine into the substance of the affected 
muscles. The so-called "late rigidity," as the result of which the 
members may be put into very injurious positions, is occasionally re- 
moved or diminished by the same expedient — viz., injecting a small 
quantity of atropine (y^ of a grain) into the contracted muscles. 
This result does not ameliorate the condition of the patient to any 
greater extent than that of affording relief to an inconvenient de- 
formity. 

The insomnia of mental disorders, and of delirium tremens, may be 
overcome by the hypodermatic injection of atropine when the follow- 
ing indications for its use are present : Coma vigil, great restlessness, 
weak action of the heart, coldness of the surface, cyanosis, clammy 
sweat. When there is a condition of hyperemia of the cerebro-spinal 
centers, excitement with elevated pulse-rate and increase of arterial 
tension, atropine can only do harm. 

The treatment of asthma by belladonna, administered by the stom- 
ach and in the form of fumigation, has already been referred to. The 
hypodermatic injection of atropine is much more effective. From y^ 
to gV of a grain may be used for this purpose ; but, as the relief comes 
from the systemic effect, it is not necessary to inject the solution in the 
neighborhood of the pneumogastric, as practiced by Courty. In order 
to procure the greatest relief, the injection should be made at the be- 
ginning of the asthmatic paroxysm, and succeeding attacks should be 
anticipated by inducing atropinism at the first warning of a seizure. 
Vomiting of pregnancy, when obstinate and resisting other means, 



BELLADONNA. 489 

is sometimes arrested promptly and permanently by the subcutaneous 
injection of atropine in small quantity (y-J-g- of a grain). Seasickness 
is relieved in the same way. In these maladies, it is better to insert 
the injection in the epigastrium. 

Cramp of the hollow muscular organs — hepatic, intestinal, uterine, 
and renal colic — may all be relieved by the subcutaneous injection of 
atropine, but the most satisfactory results are produced by the com- 
bined use of atropine and morphine. 

External Application of Belladonna Preparations. — The 
chloroformic solution of atropine is an excellent external application to 
relieve pain in nerves superficially situated. £} Chlorof ormi, spts. vini 
rect., aa 3 ss ; atropine, grs. v. M. Sig. : Apply on lint to painful part, 
and cover with oiled silk. The same application to the epigastrium 
sometimes arrests obstinate vomiting, cerebral or reflex, as, for example, 
the vomiting of pregnancy, sea-sickness, etc. A belladonna-plaster is 
an excellent application to relieve the chestpains of phthisis, to allay 
irritability of an over-excited heart, to diminish the pains and soreness 
of lumbago, myalgia, etc. 

Excessive sweating of a part, as, for example, unilateral sweating of 
the head, may be removed by brushing over the affected surface a 
solution of atropine (grs. iv — % j). 

There is no doubt that belladonna has the power to arrest the secre- 
tion of milk, in the same way that it stops the cutaneous transpira- 
tion, for the milk-gland is only an enlarged sebaceous gland whose 
function is differentiated from that of other sebaceous glands of the 
body. When it is desirable to arrest the secretion of milk, the gland 
may be enveloped by a belladonna-plaster, or the ointment of bella- 
donna may be carefully rubbed into the integument. These are rather 
disagreeable, sticky applications, which soil the clothing. A much 
more elegant method of applying this treatment is to envelop the 
breast in lint wet with a solution of atropine, four grains to the 
ounce of rose-water. As systemic effects may be produced by such an 
application, when the pupils dilate and the mouth becomes dry, it 
should be removed. Inflamed breasts may be treated in the same way. 
The mode of action of the belladonna preparations is quite obvious : 
the irritability of the terminal filaments of the nerves is allayed by the 
direct action of the atropine, and the arterioles are made to contract, 
thus diminishing the blood-supply to the inflamed tissue. 

Other superficial inflammations are subdued by the same treatment, 
as, for example, abscesses, boils, carbuncles. A plaster made of bella- 
donna extract may be kept in contact with the inflamed tissue, or the 
solution of atropine, above recommended, may be used. 

Pruritus of the vidva, vaginismus, fissure of the anus, are some- 
times relieved, as if by magic, by the use of the atropine solution 
above recommended. 



490 EXCITO-MOTORS. 

Whenever atropine is used locally for the relief of inflammatory 
pain and swelling, the efficiency of the application is much increased 
by the addition of morphine, or morphine and chloral, according to for- 
mula? to be given hereafter in the article on the latter drug. 

Secondary Products of Atropine. — Some remarkable products 
have lately been obtained from atropine by chemical processes. The 
first step consisted in the discovery, by Kraut and Losseri, simultane- 
ously, that atropine may be split up into tropine and tropic acid. Sub- 
sequently, Prof. Ladenburg succeeded in the synthesis of atropine by a 
combination of these two secondary products. If the salts of tropine 
are treated with dilute hydrochloric acid, alkaloids are produced, to 
which Ladenburg has given the name trqpeins. Homotropine is an 
alkaloid obtained from the amygdalate of tropine. The artificial atro- 
pine, prepared as above described, has precisely the same effects as the 
original alkaloid. 

Effects of Horiiotr opine. — The preparation of this base now used 
is the hydrobromate. The physiological action of this new salt has 
been studied by Ringer and Tweedy, among others. Ringer finds that, 
like atropine, homotropine paralyzes and tetanizes, but the tetanizing 
effect, which follows in forty-eight hours or more in the former, occurs 
at once in the latter. The paralyzing action is not in the nerves or 
muscles, for they respond to electrical stimulation, but in the cord, 
which is also the case with atropine. Homotropine, like atropine, in- 
creases the action of the heart by paralyzing the intra-cardiac inhibi- 
tory apparatus, and it also antagonizes muscarine. In man there is a 
marked distinction as regards the action of atropine and homotropine 
on the heart : while the former accelerates the heart considerably, the 
latter retards the beat from ten to twenty per minute, and also makes 
the action irregular. Homotropine also antagonizes the action of pilo- 
carpine, but it requires relatively more than of atropine to accomplish 
this result. Ringer sums up his observations with the remark, " Ho- 
motropine, then, appears to possess many of the properties of atropine, 
but in a weaker degree." 

Tweedy remarks that, as regards the action of atropine and ho- 
motropine relatively on the eye, the effect of homotropine on the 
iris and ciliary muscle is really very powerful while it lasts. It 
widely and fixedly dilates the pupil in from fifteen to twenty min- 
utes, and it acts on the accommodation in an equally rapid manner. 
Its effects pass off rapidly, and in twenty-four hours the accom- 
modation is restored, although the pupil is yet a little dilated. The 
application of homotropine solution to the eye is entirely unirritat- 
ing. For these reasons homotropine becomes a valuable substitute 
for atropine in ocular therapeutics, but it can not be substituted for 
atropine in the general diseases in which the latter has been found 
useful. 



STRAMONIUM. 491 

Authorities referred to : 

Bartholow, Dr. R. Prize Essay of the American Medical Association, 1869. The 
Physiological Effects and Therapeutical Uses of Atropia and its Salts. 

Ibid. Manual of Hypodermatic Medication, fourth edition, 1882. 

Bezold und Bloebaum. Untersuchungen aus phys. Laborat. in Wurzburg. Quoted 
by Stille. 

Botkin, Dr. S. Virchow's Archiv, vol. xxiv, p. 85. 

Donders. On the Anomalies of Accommodation and Refraction of the Eye, Sydenham 
Society edition. 

Eulenburg, Dr. Albert. Lehrbuch der functionellen Nervenkrankheiten, Berlin, 1871, 
p. 168. 

Fluckiger and Hanbury. Pharmacographia, pp. 407, 411. 

Fraser, Dr. Thomas R. An Investigation into some Tetanic Symptoms produced by 
Atropia in Cold-blooded Animals. From " Transactions of the Royal Society of Edin- 
burgh," vol. xxv. 

Note. — Other references omitted for lack of space, but they are to be seen in all edi- 
tions previous to the fourth. 

Stramonium. — Leaves and seed of Datura stramonium Lirme (Nat. 
Ord. Solanacece). Stramoine, Fr. ; Stechapfel^ Ger. 

Stramonii Folia. — Stramonium-leaves. 

Stramonii Semen. — Stramonium-seed. 

Extr actum Stramonii. — Extract of stramonium. Dose, gr. \ 
— gr. ss. 

Tinctura Stramonii. — Tincture of stramonium. Dose, tt|, v 
— 3 ss. 

Extr actum Stramonii Fluidum. — Fluid extract of stramonium. 
Dose, TT[ j TTi V. 

Composition. — The alkaloid of stramonium — daturine — is chemi- 
cally and physiologically nearly identical with atropine. It is contained 
in the seeds in the proportion of about one tenth per cent, and in the 
leaves in much smaller quantity. It exists in the plant in combina- 
tion with malic acid. The seeds contain a fixed oil in considerable 
quantity. 

Antagonists, Incompatibles, and Synergists, are the same as for 
belladonna. In the case of poisoning by stramonium, which is not un- 
common in this country, the seeds, which usually are taken by children, 
must be evacuated by an emetic. Unless distinct symptoms follow, no 
further treatment may be necessary ; if, however, marked dilatation of 
the pupil, hallucinations, and active delirium are produced, the physio- 
logical antagonist becomes necessary. Tincture of opium should be 
administered until some contraction of the pupil, lessening of the pulse- 
rate, and cessation of the delirium, occur. If, then, normal sleep comes 
on, the pupil, heart, and lungs functionating normally, no further in- 
terference will be necessary. In cases of poisoning in children, it is 
particularly desirable to employ the opium with caution, since opium 
narcosis may readily be substituted for stramonium-poisoning. 



492 EXCITO-MOTORS. 

Hyoscyamus. — Leaves of Hyoscyamus niger Linne* (Nat. Ord. 
Sohmacecv), collected from plants of the second year's growth. 
Jusquiame, Fr. ; JSilsenJcraut, Ger. 

Extractiim Hyoscyami Alcoholicum. — Alcoholic extract of hyos- 
cyamus. Dose, gr. | — gr. j. 

Abstraction Hyoscyami.— Abstract of hyoscyamus. Dose, gr. ss 

— g r - ij- 

Extractum Hyoscyami Fluidurn. — Fluid extract of hyoscyamus. 
Dose, in, v — 3 ss. 

Tinctura Hyoscyami. — Tincture of hyoscyamus. Dose, 3 ss 

— i ss. 

Composition. — Hyoscyamus contains two active principles — hyos- 
cyamine and hyoscine. Hyoscine is amorphous, and remains in the 
mother liquor after hyoscyamine crystallizes out. It has the appear- 
ance of a vegetable extract, but it is very active, and possesses hyp- 
notic power more considerable than its associated alkaloid. The dose 
of hyoscine ranges from -fa grain to 1 grain. 

Hyoscyamus-seeds contain more of the active principles than other 
parts of the plant. The leaves are said to be rich in nitrate of potas- 
sium also. 

Hyoscyamine unites with acids to form salts. It crystallizes in 
small, golden-yellow or whitish- yellow scales or tablets. 

Antagonists, Incompatibles, and Synergists are the same as 
for belladonna. The observation of Ladenburg, that hyoscyamine 
and cluboisine are identical, is important, and, if confirmed, will facili- 
tate the introduction of the latter into practice. As hyoscyamine 
is difficult to procure and very expensive, and as duboisine, on the 
other hand, will probably be very readily procured in any quantity, 
the latter may be substituted for the former. Clinical facts of this 
kind must be acted on with caution. Identity of chemical consti- 
tution does not always mean identity in physiological action and in 
therapeutical power. Differences in molecular arrangement, not ap- 
preciable by chemical analysis, may influence, to a great extent, the 
mode of action. The clinical facts do not, thus far, warrant the 
adoption of the view that hyoscyamine and duboisine are mutually 
convertible. 

Physiological Actions. — As atropine, daturine, and hyoscyamine 
are similar if not identical in chemical composition and in physiologi- 
cal action, the remarks already made in regard to the actions and uses 
of belladonna are applicable to stramonium and hyoscyamus. 

To these alkaloids must be added duboisine, which by Ladenburg 
is held to be identical with hyoscyamine. Studied from the physio- 
logical standpoint, daturine and hyoscyamine are regarded as identical 
in their effects by Oulmont and Laurent. As daturine is not em- 
ployed, owing to its scarcity, and as hyoscyamine has been the subject 



HYOSCYAMUS. 493 

of considerable study and clinical observation, we refer, in the follow- 
ing remarks, wholly to this alkaloid. 

Hyoscyaraine, as it occurs in commerce, prepared chiefly by Merck, 
of Darmstadt, is in two forms, a yellowish- white crystalline solid, which 
is represented as chemically pure, and a dark, resinous mass, having a 
strong, mouse-like odor, which is rather a concentrated extract, but 
appears to be little if at all inferior to the pure alkaloid, and consists, 
as is now known, for the most part, of hyoscine, and is necessarily as 
active as any salts of the alkaloid. It may be administered hypoder- 
matically in this form. As now the salts of hyoscyamine are used, 
and are freely soluble, water is the only menstruum employed to 
make solutions. The hydriodate is, however, the best form for ad- 
ministration, as it is freely soluble in water. The great variations in 
the dose of the alkaloid are due to the fact that much of the supposed 
residual extract is merely the uncrystallized hyoscine. The dose, by 
subcutaneous injection, ranges from one sixtieth of a grain to one 
fourth, and by the stomach from one sixtieth to one grain. 

Hyoscyamine causes the same dryness of the mouth, dilatation of 
the pupils, flushing of the face, rapid action of the heart and of the 
lungs, the busy delirium with hallucinations and illusions, which are 
caused by atropine, but its effects in these directions are less in de- 
gree. In the various observations which have now been made on man, 
with the considerable doses which have been found necessary in some 
cases, it has been definitely ascertained that hyoscyamine has some- 
what less than atropine of the deliriant action and much more hyp- 
notic effects. As regards the mechanism of its action on the pupil, 
on accommodation, on the heart and respiration, there is no actual 
difference between the two alkaloids. 

The elaborate investigations of MM. Oulmont and Laurent have 
conducted them to the following conclusions : Hyoscyamine and datu- 
rine act especially on the sympathetic system, in small or moderate 
doses stimulating the vaso-motor fibers and raising the arterial ten- 
sion, and in large doses paralyzing the vessels and lowering the arte- 
rial tonus. These effects are produced after section of the vagi. 
The alkaloids differ in their action on the heart — hyoscyamine render- 
ing the cardiac movements more regular, and daturine causing inter- 
mittence. By direct contact, both alkaloids slow and finally stop the 
heart's action. Both accelerate the respiratory movements. In mod- 
erate quantity both increase the intestinal movements ; in large doses 
arrest them. As regards the nervous system of animal life, they are 
both without action on the motor functions, but in toxic doses they 
blunt the cutaneous sensibility. They do not affect the contractility 
of muscular fiber. Their action in dilating the pupil is due to stim- 
ulation of the sympathetic, and not to paralysis of the third nerve. 
The various phenomena arising from the administration of these alka- 



494 EXCITO-MOTORS. 

loids are referred by Oulmont and Laurent to the circulatory disturb- 
ances — to the increased distribution of blood. The action is soon 
ended, the alkaloids being eliminated by the urine rapidly. 

Notwithstanding the freedom with which hyoscyamus and its alka- 
loid, hyoscyamine, are given, rarely are there any unpleasant effects. 
Empis, however, has reported some cases in which toxic symptoms 
happened from medicinal doses. These must have been examples of 
idiosyncrasy, for in the discussion which ensued, Joffroy, Damaschino, 
and others, expressed themselves strongly against the probability of 
serious effects from doses within safe limits. 

Therapy. — The possession of decided hypnotic qualities has led to 
the use of hyoscyamine and hyoscine in the treatment of various mental 
disorders (Prideaux, Lawson, and others). Prideaux makes the impor- 
tant practical distinction, that it acts with different degrees of rapidity 
and potency under varying conditions of insanity. In acute mania 
with depression, one sixteenth of a grain will have a marked effect, 
while in the excitement of chronic mania large doses will be necessary. 
In chronic mania with exacerbations, he gives one quarter, one half, and 
even one grain by the stomach, or one tenth of a grain subcutaneously. 
The latter mode of administration he regards preferable in these cases. 
In cases of mania with great motor excitement, and of a destructive 
character, Prideaux regards hyoscyamine as " the most rapid and reli- 
able narcotic we possess." In the epileptic mania of the epileptic 
status, he says, it diminishes the number and violence of the attacks. 
In delusional insanity he finds it brings about, under favorable circum- 
stances, mental restoration. In chronic dementia, with destructive 
tendencies and sleeplessness, improvement is sometimes noted from the 
persistent use of small doses. Reinhard also has administered this 
agent in the dose of a milligramme (about one fifteenth of a grain) 
subcutaneously in cases of mania and epilepsy, with distinctly good 
results. In eight of fifteen cases of mania, calmative effects were pro- 
duced and permanent good was accomplished ; and in five of twelve 
epileptics with maniacal attacks, the number and severity of the seiz- 
ures were lessened. Drs. Sapilli and Riva, eminent Italian alienists, 
have found hyoscyamine very useful in recurrent mania. Gill, Ringer, 
and Lawson have also had good effects from hyoscyamine, in suitable 
cases, as an hypnotic. 

Stramonium and hyoscyamus may be used like belladonna for the 
relief of painful affections, the neuralgice ; but they possess no special 
advantages over their more powerful congener. Oulmont has used the 
hypodermatic injection of hyoscyamine with remarkable success in 
several cases of neuralgia, but he does not regard it as more conspicu- 
ous and rapid in this disease than are opium and belladonna. Stramo- 
nium is used with advantage in the treatment of dysmenorrhea. 
Jjc Ext. stramonii, ext. hyoscyami, ext. opii, aa gr. vj. M. Ft. pil. no. 



HYOSCYAMUS. 495 

xij. Sig.: One pill every three, four, or six hours. This combination 
gives great relief in dysnienorrhcea, and may also be serviceable in 
neuralgia. 

In affections characterized by spasm, as asthma, laryngeal cough, 
hepatic, intestinal, renal, and uterine colic, stramonium and hyoscyamus 
may be given with advantage, in place of or in combination with bella- 
donna. The hypodermatic injection of hyoscyamine or daturine is an 
excellent expedient for procuring relief in these cases, but these alka- 
loids are not more effective than atropine. Hyoscyamus, especially in 
the form of tincture, is frequently prescribed in irritable states of the 
bladder due to the presence of stone, enlargement of the prostate, and 
in catarrh of the bladder arising by transference of irritation from the 
urethra. It should not be forgotten that liquor potassse, so much pre- 
scribed in a mixture with hyoscyamus, is incompatible. 

M. Oulmont refers, in terms which may seem to be exaggerated, 
to the great efficiency of hyoscyamine in the treatment of mercurial 
tremor, senile tremor, paralysis agitans, locomotor ataxia, and tetanus. 
In mercurial and senile tremor cures were obtained, but, as might be 
expected, only amelioration in paralysis agitans, locomotor ataxia, and 
tetanus. The remarkable benefit obtained from this remedy in paral- 
ysis agitans is testified to by Empis, Joffroy, Charcot, and many other 
observers. The dose which Oulmont found effective was the one 
thirty-second of a grain of hyoscyamine, gradually increased to the 
one fifteenth of a grain. 

The hypnotic quality is much more conspicuous in hyoscyamus than 
in belladonna or stramonium. In children it has long been known that, 
when opium is not well borne, hyoscyamus is an efficient substitute. 
Recent experience in asylum practice has shown that hyoscyamus in 
large doses is a very valuable hypnotic. According to Dr. Campbell, 
two and a half drachms of the tincture are equivalent in hypnotic power 
to thirty grains of chloral hydrate. In order to procure efficient hyp- 
notic effects, from two drachms to an ounce of the tincture is neces- 
sary, and this large quantity appears to be free from danger. 

Extract of hyoscyamus is used in combination with purgatives, 
with the object — which abundant clinical observation confirms — of 
rendering their operation more efficient, no doubt, because of its 
action on the muscular layer of the intestine. 

The ointment of stramonium is a favorite application to irritable 
ulcers, superficial inflammations, etc. 

Hyoscine. — This is a new alkaloid obtained from the mother- 
liquor, as already shown, and which has been produced synthetically 
by Ladenburg. It forms a crystalline combination with hydriodic 
acid, and an amorphous salt with hydrochloric. These salts dissolve 
freely in water. The solution employed by Edfelsen for administra- 
tion by the stomach contained about -fa gr. to the tablespoonf ul, and 



496 EXCITO-MOTORS. 

for subcutaneous injection, jfa gr. to one minim. These are suitable 
doses for administration. 

The physiological effects of hyoscine have been studied by Laden- 
burg, the discoverer ; by Edfelsen, and others. Generally speaking, 
the effects of this agent correspond quite closely to those of atropine, 
but in corresponding doses the latter is more powerful. When admin- 
istered subcutaneously, hyoscine acts in two to twelve minutes ; by the 
stomach in about fifteen minutes. It causes more drowsiness and sopor, 
and less delirium than atropine, but like the latter dilates the pupil, 
increases the rate of the cardiac and respiratory movements, and red- 
dens the skin. According to Gnauck, the pulse is first slowed eight to 
twenty beats per minute, and after ten to twenty minutes rises. The 
same phenomenon is observed from atropine in some subjects, but is 
not so pronounced. Dilatation of the pupil does not always occur 
after the stomachal administration. Sleep comes on in twenty to thirty 
minutes, preceded by a feeling of lassitude, and is deep and quiet, but 
is followed by headache and vertigo. As a cerebral sedative, Bruce 
assigns it to a high place, but a period of excitement prefaces tne 
decline of action, and hence a true statement of its powers can be 
made when both stages of its action are duly accounted for. 

Instilled into the eye, hyoscine is a more energetic mydriatic than 
atropine, dose for dose (Emmert). One part of the hydriodate to one 
thousand of water is the solution used by Emmert, and this he finds 
more active than a half-per-cent solution of atropine. 

Hyoscine has been employed in various diseases requiring a sopo- 
rific and anodyne agent. In general, it can be used in the same cases 
as atropine, but, as it possesses more decided antispasmodic effects, it 
may prove more valuable. By Ladenburg it has been used success- 
fully in whooping-cough, in asthma, and in enter •algia. Half the cases 
of whooping-cough were relieved, and all of the cases of asthma were 
more or less benefited, some decidedly so. 

In ophthalmic practice, hyoscine can be substituted for atropine. 
It causes more prompt and decided, but less persistent, dilatation of 
the pupil, and it is less poisonous (Emmert). It is applicable to 
the same purposes in eye-diseases as those in which atropine is now 
employed. 

Authorities referred to : 

Bucknill and Tuke. Manual of Psychological Medicine, London, 1874, p. '727. 

Campbell, Dr. Journal of Mental Science, No. lxxx, 1871. 

Edfelsen und Illing. Ueber die therapeutische Vemvendung des Hyoscinum hydrochlo- 
ricum und hydriodicum. Centralblatt f d. med. Wissensch., No. 23, 1881. 

Emmert, Dr. Correspondenz-Blatt, January 15, 1882 ; by London Medical Record, 
February, 1882. 

Empis, Dr. Hyoscyamine, accidents causes par son emploi. Bull. Gen. de Therap. y 
Juin 15, 1881. 



DUBOISIA. 497 

Fronmttller, Dr. Klinische Studien uber die schlafmachende Wirkung dcr narkotischen 
Arzneiraittel, Erlangen, 1875, p. 70. 

Gnauck, Dr. A. Ueber die Wirkungen des Hyoscine. Centralblatt fur die rned. Wis- 
sensch., No. 45, 1881. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimiilellehre, zweiter Band, 
p. 1115, et scq. 

Ladenburg, Prof. Dr. Ibid. No. 23, 1881. 

Laurent, M. le Dr. De V Hyosciamine et de la Daturine. These. 

Oulmont, M. le Dr. Be V Hyosciamine et de son Action dans les Nevroses. Bulletin 
General de Therapeutique, vol. lxxxiii, p. 481. 

Prideaux, E. The Action and Uses of Hyoscyamine. Bancet, 1879, September 27, 
October 4 and 11. 

Reinhard, Dr. C. Archiv fur Pschy. und JVcrvenkrankh., Band xi, p. 121. 

Duboisia. — JDuboisia myoporoides, of the Solanacece. 

Peepaeations. — There are no official preparations ; but the fol- 
lowing can be employed in any of the cases requiring it : 

Extractum Duboisiw. Dose, gr. -^ to gr. ^. 

Duboisinm /Sulphas, or Hydrobromas. — Dose, gr. j±^ to gr. Jq. 

'Composition. — The important constituent is an alkaloid — duboi- 
sine — which possesses the medicinal powers and properties of the 
plant. It combines with acids to form salts which are freely soluble 
in water. As regards its chemical relations, duboisine strongly re- 
sembles atropine, but differs in some particulars ; according to La- 
denburg, duboisine is identical with hyoscyamine ; but here again 
we have an illustration of the important fact that identity of compo- 
sition does not necessarily imply identity of physiological action and 
therapeutical power. The dose of a salt of duboisine is y-J-g- to -^ of 
a grain. 

Antagonists and Incompatibles. — The caustic alkalies destroy 
the active principle, and consequently prescriptions containing them 
will be inert, except as to the effects of the alkali. The physiological 
antagonists are the same as those of atropine ; thus physostigmine and 
muscarine counterbalance the action of duboisine in almost the entire 
range of power, and opium in a limited degree. Duboisine antagonizes 
pilocarpine, as respects, at least, the most conspicuous and important 
properties of the latter. In case of poisoning, emetics and the stom- 
ach-pump must be used, and the systemic effects opposed by the sub- 
cutaneous use of physostigma, muscarine, or morphine, cautiously, and 
certainly pilocarpine, further researches having proved the antagonism 
of the last named. 

Syneegists. — The actions of duboisia are promoted by the other 
agents of the group, especially by belladonna, stramonium, and hy- 
oscyamus. The effects of atropine and duboisine correspond to a 
remarkable extent, but there are points of difference, as follows : 
Duboisine is twice or more soluble in water than atropine ; it has 
stronger basic properties, and it reacts differently to sulphuric acid 
33 



49S EXCITO-MOTORS. 

and bichromate of potassa ; it is less irritating to the conjunc- 
tiva, dilates the pupil more promptly, and its effects subside earlier 
(Gerard). 

Physiological Effects. — Dryness of the mouth, thirst, and some 
difficulty in swallowing, soon follow the administration of duboisia, 
and more speedily after the subcutaneous injection of the alkaloid. 
The pulse is considerably accelerated ; the arterial tension rises, the 
face flushes, the pupil dilates, and the accommodation is paralyzed. 
Some frontal headache, tinnitus aurium, giddiness, and restlessness, 
especially in sleep, are experienced. Certain motor symptoms — uncer- 
tain gait, awkwardness of movement in walking, and muscular paresis 
— occur (Gubler). In animals mental excitement or delirium has been 
noted, but no confirmatory or opposing observations on man have thus 
far been reported. The tetanic symptoms which occur after some 
days in frogs poisoned by atropine, take place under the same condi- 
tions from duboisia. 

The acceleration of pulse and rise of tension first produced by 
duboisia do not persist ; the pulse-rate and the tension fall after 
some hours, the excitement subsides, and a condition of stupor 
comes on which is not sleep, although it favors sleep (Gubler). I 
can confirm these important observations on the cerebral effects of 
duboisia. 

Theeapt. — The author has prescribed duboisine in cases of puer- 
peral mania with excitement, on the suggestion of M. Gubler, and 
with entire success. There is an increase of the maniacal excite- 
ment for a few hours after the hypodermatic injection, but this is 
followed by the condition of stupor and mental calm. The im- 
provement is rapid, and follows so closely the administration of 
the remedy that he could not doubt it was propter and not merely 
post hoc. 

As respects its use in ophthalmic diseases, it may be stated in gen- 
eral that duboisine is applicable under the same conditions as atropine, 
to which it is to be preferred, in many cases, it is probable. 

The advantages of duboisine, as compared with atropine, are its 
greater rapidity of action in effecting dilatation of the pupil and pa- 
ralysis of accommodation, the less irritation of the conjunctiva, and 
the more rapid recovery from the effects. It is, therefore, much more 
useful than atropine for determining the refraction of the eye, and for 
use in ocular therapeutics in general. 

Some unpleasant cerebral effects have been observed after instilla- 
tion into the eye (Seely). The author was given the opportunity, 
by the kindness of Dr. Seely, to examine the patient — the first in- 
stance in which such phenomena were observed — who experienced 
faintness and strange sensations in the head ; but they were entire- 
ly subjective and mental, as no change in the circulation or respi- 



CAMPHOR. 499 

ration was to be seen. Since that case there have been several 
examples of the systemic action of duboisine after its instillation 
into the eye. 

To relieve the night-sweats of phthisis and the various neuroses of 
the respiratory organs, and to stimulate the action of the heart, du- 
boisine may take the place of atropine. As an antagonist to mor- 
phine it is equally as effective as atropine, but, as a hypnotic and 
anodyne, superior to the latter. 

Authorities referred to : 

Bancroft, Dr. Joseph. The Lancet, March 2, 1878. 

Gerrard, Mr. London Medical Record, vol. vi, 1878, p. 156. 

Gubler, Prof. A. Bull. Gen. de Therap., vol. xciv, p. 426. 

Lauersau, de, Prof. Lull. Gen. de Therap., supra, p. 362. 

Norris, Prof. W. F. The American Journal of the Medical Sciences. April, 1879, pp. 
466, et seq. Duboisia as a Mydriatic, etc. 

Ringer, Prof. Sydney. The Lancet, supra. 

Seely, Prof. W. W. Lancet and Clinic for 1879, January, February. Various arti- 
cles on the use of Duboisine. 

Tweedy, Mr. John. The Lancet, supra. On the Mydriatic Properties of Du- 
boisia, etc. 

Weeker, Dr. L. Bull. Gen. de Tfierap., supra, p. 337. De Vemploi compare de Vese- 
rine, de V atropine, et de la duboisine en therapeutique oculaire. 



B.— AGENTS EXCITING THE FUNCTIONAL ACTIVITY OF THE CEREBRUM. 

To this group belong those remedies usually classed together 
under the designation of antispasmodics. They are to a slight de- 
gree cardiac stimulants ; they increase the cutaneous circulation 
and promote diaphoresis ; they also stimulate the bronchial mucous 
membrane and favor expectoration. As a result in part of the 
increased rapidity of the circulation, the functions of the brain be- 
come slightly more active, ideas flow more freely, irregular mental 
excitement and muscular hyperkinesis are moderated, and an orderly 
feeling of well-being is experienced. These effects are probably in 
part due to a direct action of these agents on the gray matter of the 
hemispheres, but our knowledge does not at present permit an exact 
statement of the nature of this impression. These agents do not in 
any quantity suspend the functions of the brain, and the temporary 
increase of activity which they produce is not followed by manifest 
depression. 

Camphora. — Camphor. Camphre, Fr. ; Campher, Ger. A stea- 
ropten derived from Cinnamomum camphora F. Nees et Ebermaier 
(Nat. Ord. JLaiiracece), and purified by sublimation. 



500 CEREBRAL EXCITANTS. 

Aqua Camphorce. — Camphor- water. Dose, 3 j — 3 j. 

Lhumcrttum Camphorce. — Camphor-liniment. (Camphor, 20 parts ; 
cotton-seed oil, 80 parts.) 

Linimentum Saponis, — Soap-liniment. (Soap, camphor, oil of rose- 
mary, alcohol, and water.) 

Spiritus Camphorce. — Spirit of camphor. (Camphor, 10 parts ; 
alcohol, 75 parts ; water, 20 parts.) Dose, ttl v — ttj, xx. 

Camphor a Monobromata. — Monobromated camphor. Dose, grs. 
ij — grs. x. Colorless, prismatic needles or scales, permanent in the 
air and unaffected by light, haying a mild camphoraceons odor and 
taste, and a nentral reaction. Almost insoluble in water ; freely solu- 
ble in alcohol, ether, chloroform, and fixed oils ; slightly soluble in 
glycerin. 

Composition and Peopeeties. — Camphor is found in colorless, 
translucent, crystalline masses. One part dissolves in about 1,300 
parts of water, but it is freely soluble in alcohol, ethers, oils, chloro- 
form, bisulphide of carbon, etc. Its odor is peculiar and characteristic. 
The formula for camphor is the following : C 10 H ]6 O. By distillation 
with chloride of zinc it is converted into cymol, and by oxidizing 
agents into camphoric and camphretic acids. 

Antagonists and Incompatibles. — The addition of water pre- 
cipitates camphor from its spirituous solution. Alkaline and earthy 
salts, for example sulphate of magnesium, separate from its solution 
the small quantity of camphor contained in aqua camphora?. Coffee, 
the arterial sedatives, cold, and depressing causes generally, antago- 
nize its physiological action. 

Syneegists. — All the remedies of this group, and alcohol, opium, 
and narcotic substances, increase the effects of camphor. 

Physiological Actions. — Applied to the skin, camphor produces 
redness, heat, and superficial inflammation, if the contact be sufficiently 
prolonged ; to an open wound its effects are still more severe. Its 
taste is hot, aromatic, and pungent. In the stomach it causes a sensa- 
tion of heat, and may excite in large doses inflammation and ulcera- 
tion. The symptoms common to irritant poisons may, therefore, be 
produced by camphor. After experimental doses in animals camphor 
has been detected in the blood of the mesenteric and portal vein, but 
not in the chyle or urine. In moderate doses (medicinal) it increases 
the action of the heart, elevates the arterial tension, and promotes 
cutaneous transpiration ; it also produces mental exhilaration, even a 
gay and lively intoxication, and allays pain. In toxic doses, in addi- 
tion to the local irritant action on the gastro-intestinal mucous mem- 
brane, and the consequent systemic effects, it lowers the pulse, the 
skin becomes pale, and the surface cold and moist, stupefies, dimin- 
ishes the reflex functions of the spinal cord, and causes convulsions, 
insensibility, and death ; but these cerebral phenomena are not sepa- 



CAMPHOR. 501 

rable from the reflex effects, on the nervous centers, of the violent 
gastro-intestinal disturbance. Sometimes dysuria has been caused by- 
camphor, and, in small doses, owing doubtless to the merely stimulant 
effects on the circulation, it increases the sexual appetite ; but, in large 
doses, it is antaphrodisiac. 

Camphor, after absorption, is eliminated chiefly by the skin and 
bronchial mucous membrane, hence the breath and sweat of those using 
this substance smell of it strongly ; but, when much camphor is taken 
in the solid form, it escapes with the faeces. 

Theeapy. — Camphor enters into the composition of many denti- 
frices. 

Camphor is contraindicated in all inflammatory affections of the 
gastro-intestinal mucous membrane. In hysterical vomiting a few 
drops of the spirit (two to five), every half-hour or hour, will often 
give relief. Camphor is an efficient remedy in summer diarrhoea. It 
is usually combined with opium : fy Spirit, camphorse, tinct. opii, aa 
| ss. M. Sig. : Ten to thirty drops every two, three, or four hours. 
3 Aqua camphorse, f iij ; tinct. lavendulaj comp., f j ; tinct. opii, 3 j 
— 3 ij- M. Sig. : A tablespoonfid every hour or two. This is an ex- 
cellent formula, omitting the opium, for flatulence, especially hysterical 
flatulence and the flatident colic which so often occurs during the cli- 
macteric period. For the preliminary diarrhoea of Asiatic cholera 
camphor is largely used, and with very obvious benefit. A drop or 
two of the saturated tincture (Rubini's), or five to ten drops of the 
spirit, may be given with a little laudanum every half -hour or hour. 
Oppolzer gave the ethereal tincture with opium : fy Camphorse, § j ; 
etheris, f vij ; tinct. opii, % j. M. Sig. : Twenty to forty drops, as 
necessary. Camphor, which is very serviceable in the summer diar- 
rhoea of children, may be given to these little subjects in milk, in 
which it is soluble in the proportion of one drachm to four ounces. 

Spirits of camphor, in the form of vapor, is a useful inhalation in 
the incipiency of acute catarrh. Dr. Beard speaks in very enthusias- 
tic terms of a camphor preparation which he has called " cold powder." 
This formula is as follows : " Camphor, five parts. Dissolve in ether 
to the consistence of cream. Then add carbonate of ammonium four 
parts, opium-powder one part." The dose of this ranges from three 
to ten grains. Dr. Beard finds this combination of " great value in 
breaking up colds, when taken in time, and in modifying their force 
when taken late." 

Camphor was formerly much used in the treatment of asthma, but, 
at present, more efficient remedies have taken its place. The mono- 
bromide of camphor has proved decidedly beneficial in whooping-cough. 
Five grains, suspended in mucilage and sirup of tolu, may be given to 
a child three or four times a day. It is most serviceable in the spas- 
modic stage, but will do good at any period. 



502 CEREBRAL EXCITANTS. 

Camphor will allay cough and promote expectoration, hence its 
utility in chronic bronchitis, in capillary bronchitis when stimulants 
are needed, and in emphysema. In the so-called typhoid pneumonia 
camphor is serviceable as a stimulant, in small and frequently-repeated 
doses, to sustain the powers of life during the period of deferves- 
cence. 

In typhus and typhoid fevers, and in the exanthemata generally, 
camphor is used to accomplish two objects — to quiet delirium, subsul- 
tus, or restlessness, and to overcome the cardiac depression. When 
very active interference is unnecessary the following can be used : ^ 
Aqua caniphorse, liq. ammonise acetatis, aa \ ij. M. Sig. : A table- 
spoonful every two hours. 

Attacks of nervousness and hysteria are relieved by camphor-julep, 
i. e., camphor rubbed up with mucilage. Some cases of delirium tre- 
mens are benefited by camphor, but it is impossible to indicate the 
special condition requiring it. Maniacal excitement, melancholia, and 
erotomania, have also been relieved by this agent, but a great uncer- 
tainty exists as to the indications for its employment. Large doses 
are necessary in these affections, and they should at first be tentative, 
for it is not possible in the present state of our knowledge to predict 
the results of any given trial. On the whole, but little dependence is 
to be placed on camphor ; besides, more certain and effective remedies 
are now available for the treatment of these maladies. 

There appears to be a satisfactory clinical experience as respects 
the use of camphor to allay sexual excitement. Large doses (from ten 
to twenty grains) diminish the venereal appetite and the vigor of the 
erections ; hence the use of camphor in priapism, satyriasis, nympho- 
mania, chordee, etc. The following is a formula of Ricord : I£ Cam- 
phorse, lactucarii, aa 3 j. M. Ft. pil. no. xxx. Sig.: One or tic o pills, 
or more, as necessary. For nocturnal seminal losses, with weakness 
and relaxation of the genitalia, the following formula is useful : $ 
Ergotse ext. (Squibb), 3ij ; camphorse, 3 j. M. Ft. pil. no. xxx. 
Sig. : Two at bed-hour. A full dose of camphor will often arrest the 
strangury produced by blisters. 

Considerable testimony has been collected showing the value of 
camphor as a remedy in senile gangrene, and in hospital gangrene. 
Five to fifteen grains every four hours may be given in an emulsion, 
and powdered camphor may be applied freely to the sloughing surface. 
A clyster of camphor is an effective remedy against ascarides. 

Camphor was a favorite remedy with Dewees for dysmenorrhoea. 
He gave ten grains in a mixture with mucilage and cinnamon-water, 
and repeated the dose in an hour or two if necessary. For after-pains, 
camphor (ten grains), in a mixture with a little morphine (one eighth 
of a grain), is an effective remedy. 

Exteexal Uses. — A cataplasm of camphor, morphine, and flax- 



ASAFOETIDA. 503 

seed, applied to the cheek, will relieve toothache. Camphorated oil is 
a mild counter-irritant, which is a useful external application for the 
relief of internal inflammations. The solution of camphor in ether has 
been applied locally with benefit in erysipelas. Myalgia, lumbago, 
and neuralgia of superficial nerves, may sometimes be relieved by 
frictions with camphorated oil or soap-liniment. Powdered camphor, 
freely sprinkled over the surface, is one of the means resorted to, and 
sometimes with success, to prevent pitting of the face from variola. 

Camphor and chloral triturated together form a clear liquid, 
which will take up morphine, atropine, and other alkaloids, in large 
quantity. The solution containing the alkaloids can be mixed with 
chloroform without precipitation. This constitutes a topical applica- 
tion of great power, which can be utilized in the treatment of pain 
and inflammation, painted over the part affected by a camel's-hair 
brush, or by means of absorbent cotton saturated, covered with oil- 
silk, and kept in position as long as it can be borne. This solution 
may be given internally also, but, as it is irritating, only in small 
doses, and after meals. 

The formula used by the author is : Equal parts of camphor and 
chloral ; after it is liquefied by trituration, morphine and atropine 
are added, and then some pure chloroform mixed in drop by drop. 
Thus : Pj6 Camphorae, chloral, aa § ss. Mix, and add morphinae 
sulph., 3j ; atropine sulph., gr. v. When dissolved, add slowly, 
chloroformi, 3 ss. 

Authorities referred to : 

Beard, Dr. George M. Archives of Electrohgy, 18*74, p. 272. 

Fluckiger and Hanbury. Pharmacographia, article Camphora. 

Gubler, Dr. Adolphe. Bulletin General de Therapcutique, December 30, 1871. 

Harley, Dr. John. The Physiological Action of Camphor. The Practitioner, vol. 
ix, p. 210. 

IIusemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, Berlin, 1875, 
zweiter Band. 

Kohler, Prof. Dr Hermann. Handbuch der phys. TherapeutiJc. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii, article Camphor. 

Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii, huitieine edition. 

Von Grisar, V. PharmaJcodynamik der ath. Oele, Diss., Bonn, 1873. 

Asafcetida. — Asafoetida. A gum-resin obtained from the root of 
Ferula narthex Boissier, and of Ferula scorodosma Bentham and 
Hooker (Nat. Ord. Umbelliferce, Orthospermoe). (IT. S. P.) Asa- 
foetida, Fr. ; Tenfelsdreck, Ger. 

Emplastrum Asafoetidce. — Asafoetida-plaster. 

Mistura Asafoetidm. — Asafoetida-mixture. Dose, f ss — f ij. 

Tinctura Asafoetidm. — Tincture of asafoetida. Dose, 3 ss — 3 ij. 

Pilulce Asafoetidm. — Pills of asafcetida. (Asafoetida and soap.) 
Dose, 1 — 4 pills. 



504 CEREBRAL EXCITANTS. 

PilulcB Aloes et Asafcetidm. — Pills of aloes and asafoetida. (Asa- 
foetida, aloes, soap.) Does, 1 — 4 pills. 

Tihdee Galbani Composites. — Compound pills of galbanum. (Asa- 
foetida, galbanum, and myrrh.) Dose, 1 — 4 pills. 

Composition. — About one half of the gross constituents of asafoetida 
consists of resin. This is not wholly soluble in chloroform or ether. It 
contains a peculiar acid (ferulaic acid). Asafoetida also contains a 
sulphureted and phosphureted volatile oil, in the proportion of from 
three to five per cent. This oil is at first neutral, but becomes acid by 
exposure to the air, and evolves sulphureted hydrogen. It possesses 
in a high degree the disagreeable odor of the drug. 

Asafoetida also contains malic acid, and acetic, formic, and vale- 
rianic acids are products of the watery distillation. There is sufficient 
gum present also to form an emulsion with water. 

Antagonists and Incompatibles. — Acids, neutral salts, cold, and 
arterial sedatives, oppose the action of asafoetida. 

Synergists. — The gum-resins, the balsams, and the aromatics, es- 
sential oils containing sulphur and phosphorus, and alcohol and ether, 
promote the physiological and therapeutical activity of asafoetida. 

Physiological Actions. — Asafoetida possesses an extremely char- 
acteristic odor, and a pungent, rather hot, and faintly acrid taste. It 
excites by its presence in the fauces an increased flow of saliva. It 
stimulates secretion from the gastro-intestinal mucous membrane, pro- 
motes the appetite, improves digestion, and increases peristalsis. The 
faeces are somewhat softer, and are very offensive from the presence in 
them of sulphur and phosphorus compounds, resulting from the de- 
composition of the essential oil. In large quantity asafoetida causes 
nausea, vomiting, and purging. The active principle (the essential 
oil) undoubtedly slowly diffuses into the blood, for the odor of it is 
detectable in the sweat and breath. Increased action of the heart, a 
higher temperature of the surface (subjectively, at least), more or less 
diaphoresis, and diuresis, have been observed to follow its medicinal 
administration. It acts as a gentle stimulant to the brain, induces a 
feeling of well-being, increases the flow of ideas, and causes, as the 
author has observed in one case, certainly, sufficient exhilaration of a 
pleasant kind to be regarded as an intoxicant. 

Asafoetida is eliminated by the skin, intestinal and bronchial mu- 
cous membrane, and in small part by the kidneys. The functions of 
all these organs are increased in activity by the local stimulant effect. 
Partly due to the general rise of arterial pressure which it produces, 
partly to its local action in the process of elimination, and partly to its 
phosphorus compounds, asafoetida increases the menstrual flux, and, in 
both sexes, the venereal appetite. 

Therapy. — Asafoetida is used in the country of its habitat as a 
condiment. A little — very little — rubbed on the gridiron, improves 



ASAFCETIDA. 505 

the flavor of beefsteak. If it were not for its intolerable odor, and for 
the horrible eructations which follow its use, even when disguised in a 
sugar-coated pill, it would be much employed as a stomachic tonic in 
atonic dyspepsia, accompanied by torpor of the intestines. For the 
flatulent colic of infants no remedy is better than mistura asafoetidce, 
which may be given in teaspoonful doses. It is especially in the flatu- 
lence of hysteria and hypochondriasis that this remedy is serviceable. 
It expels the flatus, promotes intestinal secretion and digestion, and 
relaxes the bowels. In this way the mind is relieved, for the action 
of asafoetida extends beyond this improvement in the state of the 
chylopoictic viscera — it induces a condition of mental cheerfulness 
which takes the place of the abnormal mobility of hysteria, and of 
the gloom of hypochondriasis. 

The official pill of aloes and asafcetida is an excellent combination 
for the relief of constipation, when associated with amenorrhea. It 
is adapted, of course, to those cases in which there is a condition of 
anaemia rather than of plethora, and in which there exists a state of 
torpor of the ovaries, as well as of the intestinal canal. These condi- 
tions existing, the combined pill of aloes and asafcetida is indicated 
whether hysteria be present or not. 

The chronic scaly eruptions, chronic eczema, etc., especially when 
the skin is dry and harsh, are much improved by the persistent use of 
asafoetida. 

Bronchorrhcea, bronchitis after the acute symptoms have subsided, 
the CGugh maintained by habit which may succeed the whooping-cough, 
and the sympathetic cough of mothers whose children are experiencing 
whooping-cough, are greatly benefited by asafcetida. I> Mist, asaf ceti- 
dse, | iv ; ammonii muriat., 3 j. M. Sig. : A tablespoonful as neces- 
sary. 

Asafcetida, which was formerly much prescribed in asthma,, whoop- 
ing-cough, and other neuroses of the respiratory organs, has been sup- 
planted by more efficient remedies. 

The disagreeable odor of asafoetida, which is a bar to its employ- 
ment in many of the diseases to the treatment of which it is very well 
suited, is not an objection to its use in hysteria, hypochondriasis, and 
epilepsy. The moral effect of its repulsive odor is not without influence 
in the psychic realm. But the effect of asafoetida is not simply on the 
imagination of the patient ; it has constituents of very positive quality, 
which impress the brain. Hence the utility of asafoetida to arrest the 
hysterical paroxysm, and to relieve the numerous maladies in which 
the hysterical constitution disports itself. The remarks already made 
in regard to the action of asafcetida on the digestive functions in hypo- 
chondriacal subjects, render it unnecessary to speak more at length on 
the use of this remedy in hypochondriasis. Asafoetida is no longer 
employed in the treatment of epilepsy, except in the so-called hystero- 



506 CEREBRAL EXCITANTS. 

epilepsy. The convulsion of childhood, from reflex irritation, are 
sometimes relieved by this remedy, but it is entirely without utility in 
convulsions arising from renal or cerebral disease. 

AmmoniacilHl. — Ammoniac. A gum-resin obtained from Dorema 
Ammoniacum Don (Nat. Ord. Umbelliferce, Orthospermm) (TJ. S. P.). 
Gomme ammoniaque, Fr. ; Ammoniakgummi, Ger. 

Emplastrum Ammoniaci. — Ammoniac-plaster. 

Emplastrum Ammoniaci cum Hydrargyro. — (Ammoniac, mercury, 
diluted acetic acid, and lead-plaster.) 

Mistura Ammoniaci. — Ammoniac-mixture. (The resin is sus- 
pended by the gum in water.) Dose, 1 ss — f j. 

Composition. — Ammoniac contains a volatile oil, which differs from 
the asafoetida oil in not containing sulphur. It has the odor of the 
drug. Ammoniac also contains gum and resin, the latter in the pro- 
portion of about seventy per cent. 

Antagonists, Incompatibles, and Synekgists, same as for asa- 
foetida. 

Physiological Actions. — The effects of ammoniac are similar to 
those of asafoetida, but it is much less active, owing to the fact, chiefly, 
that its volatile oil does not contain sulphur and phosphorus com- 
pounds. 

Therapy. — Ammoniac may be used for the same purposes as asa- 
foetida, but it is much less efficient than the latter. At present its use is 
almost entirely restricted to chronic bronchial affections, in which the 
mistura is prescribed usually with the carbonate or chloride of ammo- 
nium. Ammoniac-plaster is sometimes used as a discutient to indo- 
lent glandular and inflammatory swellings. 

Authorities referred to : 

Fluckiger and Hanbury. Pharmacographia. 

Gubler, Dr. A. Comment aires Therapeutiqv.es. 

Husemann, Dr. Theod. Handbuch, etc., zweiter Band, p. 987. 

Kohler, Dr. Hermann. Handbuch, etc., erste Ealfte, p. 392. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, fourth edition. 

Trousseau et Pidoux. Traite Therap. et Mat. Med., vol. ii. 

Valeriana. — Valerian. The rhizoma and rootlets of Valeriana offi- 
cinalis Linne (Nat. Ord. Valerianacece). (U. S. P.) Valeriane, Fr. ; 
Baldrianwurzel, Ger. 

Abstractum Valerianae. — Abstract of valerian. Dose, gr. v — 3j. 

JExtractum Valerianae Fluidum. — Fluid extract of valerian. Dose, 
3 ss— 1 ss. 

Tinctura Valeriance. — Tincture of valerian (20 parts to 100). Dose, 
3ss— 3 ij. 

Tinctura Valerianae Ammoniata. — Ammoniated tincture of vale- 
rian (20 parts to 100 spts. ammon. aromat.). 



VALERIAN. 507 

Ammonii "Valerianas. — Valerianate of ammonia. Is a white salt, 
in the form of quadrangular plates, having the disagreeable odor of 
valerianic acid, and a sharp, sweetish taste. It deliquesces in a moist 
air, but effloresces in a dry one, and is very soluble in water and in 
alcohol. It is decomposed by potassa, with evolution of ammonia, and 
by the mineral acids with separation of valerianic acid, which rises to 
the surface in the form of oil. 

Oleum Valerianae. — Oil of valerian. Dose, tii ij — tti iv. 

Composition. — Valerian contains from one to two per cent of an 
essential oil, which, if distilled from the perfectly fresh plant, has but 
little odor. In the process of drying of the root, or on exposure to the 
air of the oil distilled from fresh roots, valerianic acid is formed. 
As obtained from the dried root, the oil of valerian consists of valeri- 
anic acid, a camphor, valerene, and valerol. 

An acid strongly resembling valerianic is obtained by the oxida- 
tion of amylic alcohol ; but the two acids are not identical. The 
valerianic acid of pharmacy is, however, obtained in this way, and the 
various valerianates are products of the combination of the acid formed 
from amylic alcohol with bases. 

Antagonists and Incompatibles. — Quinine, digitalis, ergot, and 
remedies acting similarly, antagonize the actions of valerian. 

Synergists. — All the agents of this group, opium, alcohol, ether, 
etc., increase the action of valerian. 

Physiological Actions. — Valerian and its preparations have a 
hot, pungent taste, and a peculiar and disagreeable odor. A sensation 
of warmth at the epigastrium follows when it is taken into the stom- 
ach. In large doses, nausea, hiccough, eructations of the drug, vomit- 
ing, and diarrhoea, may be produced. In small doses no appreciable 
physiological effects are observed ; but in considerable doses the action 
of the heart is increased, the temperature of the surface rises, and dia- 
phoresis occurs. As respects the nervous system, headache, vertigo, 
exhilaration of mind, spectral illusions, hallucinations, have, it is said, 
been produced by valerian ; but these results are by no means constant 
phenomena. According to Von Grisar (Kohler), oil of valerian re- 
duces the reflex excitability, motility, and sensibility, and antagonizes 
the tetanizing action of brucine. 

The odorous principle — valerianic acid — appears in the sweat, 
breath, and also the urine. 

Therapy. — The flatidence of the hysterical and hypochondriacal 
is quickly relieved by the tincture or fluid extract of valerian. 

It sometimes happens that a mild attack of spasmodic asthma may 
be relieved by valerian, but this by no means efficient remedy quickly 
loses its effect. Whooping-cough, laryngismus strididus, and other 
neuroses of the respiratory organs, may be occasionally modified by 
this agent ; but it is by no means equal to many other remedies now 
available. 



508 CEREBRAL EXCITANTS. 

The chief therapeutic use of valerian is in the treatment of nerv- 
ousness, hysteria, and hysterical disorders generally. There can be no 
difference of opinion as to its great value in these cases ; but as re- 
spects epilepsy, chorea, paralysis agitans, etc., in which it was for- 
merly used, it must suffice to say that it is now never prescribed. 

Under the impression that the physiological and therapeutical ac- 
tivity of valerian depends on valerianic acid, various valerianates have 
been introduced into practice. The only one which requires notice 
here is the valerianate of ammonia, which in the form of elixir is fre- 
quently prescribed in hysterical affections. Fluid extract of valerian 
has been used with advantage in diabetes insipidus and also in saccha- 
rine diabetes, but the results are not permanent. It diminishes the 
amount of urinary water in both, and lessens the excretion of sugar in 
the latter, but these effects continue only while the remedy is given. 

Authorities referred to : 

Fluckiger and Hanbury. Pharmacographia. 

Hcsemann, Dr. Theodor. Handbuch der gesammten Arzneimitlellehre, zweiter Band. 

Husemann, Drs. Aug. und Theo. Die Pflanzenstoffe. 

Kohler, Dr. Hermann. Handbuch der physiologischen Therapeutik, etc., erste Halfte. 

Trousseau et Pidoux. Traite de Therapeutique et de Mat. Med., huitieme Edition. 

Cannabis Indica. — Indian cannabis. The flowering tops of the 
female plant of Cannabis sativa Linne (Nat. Ord. Urticacew, Cannabi- 
neai), grown in the East Indies. Chanvre Indien, Fr. ; JTanf kraut, Ger. 

Cannabis Americana. — American hemp. Although recognized, no 
official preparations should be made of it ; and yet there is reason to 
believe it is thus used. 

Pkepaeations. — Extraction Cannabis Indicm. — Extract of canna- 
bis Indica. Dose, gr. J — gr. ij or more. 

Extractum Cannabis Indicm Eluidum. — Fluid extract of canna- 
bis Indica. Dose, fii ij — 3 ss. 

Tinctura Cannabis Indices. — Tincture of cannabis Indica. Dose, 
ni v— 3 j. 

Cannabinum Tannicum. — Dose, gr. j — gr. x. 

Composition. — The most important constituent of hemp is a pecul- 
iar resin, cannabin, which possesses the active powers of the plant. 
By distillation of the leaves and stems, a peculiar volatile oil is ob- 
tained ; and this is divisible into cannabene, a very light hydrocarbon, 
and hydride of cannabene, a solid crystalline substance. 

An impure resin, collected in an imperfect and crude way from the 
leaves and stems, is known as charas or churrus. Bhang consists of 
the dried leaves and stalks made into a confection with preserved fruits 
and aromatics, and in this form constitutes the well-known hashish. 
Gunjah is the female flowering plant, dried, from which the resin has 
not been extracted. There are important differences of opinion as to 
the active constituents. According to Roux, the new preparation — 



CANNABIS INDICA. 509 

the tannate of cannabin — has no obvious effects, is in fact inert. The 
volatile oil, which Personne thinks is the true active principle, has also 
been shown to have no special power. The alcoholic extract is inert, 
and Duquesnel's proved to be no more active. The resin, it seems to 
be demonstrated, is the active part, or contains it. The petroleum 
(rhigolene or benzine ?) extract has excitant and convulsive property, 
and is distinctly toxic. 

No arbitrary rules for the dose can be laid down. In beginning 
the use of any newly-made preparation, it is safer to commence with 
the minimum dose. Having, by gradually increasing the quantity, 
ascertained the physiological activity of that particular specimen, it 
may then be pushed according to the necessities of the case. 

Antagonists and Incompatibles. — The caustic alkalies, the acids, 
strychnine, and induction electricity, oppose the actions of hemp. In 
cases of poisoning, the stomach should be evacuated, and symptoms be 
combated as they arise. Strychnine may be injected hypodermatical- 
ly, and the respiration be maintained by faradization of the respiratory 
muscles. As, however, hemp possesses but feeble toxic power, cases 
of acute poisoning have never been reported. 

Synekgists. — Alcohol, ether, nitrous oxide, the mydriatics — bella- 
donna, hyoscyamus, etc. — opium, and the cerebral stimulants general- 
ly, promote the actions of hemp. 

Physiological Actions. — The resin of hemp is a soft solid ; is 
soluble in alcohol and in ether, in the fixed and volatile oils, and in 
the fats. It has a balsamic taste, but is bitter and acrid. It promotes 
the appetite and the digestion somewhat. The most important actions 
are those referable to the nervous system. There is a distinction to 
be made between the effects on the nervous system of the inhalation 
of the fumes of hashish and those effects which follow the stomach 
administration. Inattention to this point has, probably, given rise to 
most of the confusion regarding the physiological actions of this rem- 
edy. When inhaled it produces a singular muscular erythism and agi- 
tation, a great desire for muscular activity and motion, an entire absence 
of the sense of fatigue ; but these sensations are followed by exhaus- 
tion, even by syncope. Hallucinations occur, but they are not usually 
agreeable ; they are often painful, and are replaced by stupor. 

By the stomach, and in moderate doses, hashish is an excitant of 
the nervous system, increasing intellectual and motor activity. In 
large doses, it lowers the tactile sense and the sense of pain — in other 
words, it is analgesic and anaesthetic — and it induces a cataleptic state, 
in which the muscles maintain any position in which they may be 
placed. The mental intoxication is ordinarily of an agreeable kind ; 
the ideas flow more easily, are highly pleasurable, and are usually ac- 
companied by bursts of gay laughter. Not unfrequently the excite- 
ment takes the form of a furious delirium, in which acts of violence 



510 CEREBRAL EXCITANTS. 

are committed — whence the name "haschaschins," or assassins, applied 
to the unfortunate hashish-eater who, under the influence of the drug, 
commits murder. It has been maintained, and probably rightly enough, 
that the form which the delirium takes represents the mental and moral 
condition of the individual in his normal state : those who are amiable 
and gay become more so under the influence of hashish ; and those 
possessed of evil and malignant dispositions enact deeds of violence. 

Under the influence of hashish the knowledge of time is lost ; such 
are the number and variety of the images which occupy the mind, 
that a few minutes appear to be hours, days, or even years. After the 
effects of the drug have passed off, the hashish-eater is usually uncon- 
scious of the events that have transpired. Sleep or coma, according 
to the dose, ends the effects of the drug. 

Dilatation of the pupil, and disorders of vision, which contribute to 
the hallucinations by the distortion of external objects, are produced 
by hemp. Aphrodisiac effects are said to follow the use of hashish ; 
but impotence, which is common in hashish-eaters, doubtless results 
from the repeated over-stimulation of the sexual organs. 

It is not known by what organs, or in what form, hashish is elimi- 
nated. The effects of a large dose are not entirely expended in twenty- 
four hours, and those who have taken it by way of experiment have 
suffered vertigo, headache, and other cerebral symptoms, for some time 
subsequently. It does not increase any of the secretions, except it may 
be the urinary, somewhat ; and it does not stimulate into increased 
activity any organs except the cerebro-spinal and the sexual. The 
sleep or stupor which it produces, and which comes on after the stage 
of excitement, is not followed by after nausea and depression, as in the 
case of opium. 

Therapy. — The extract of cannabis Indica enters into the compo- 
sition of chlorodyne, a nostrum which has had a great reputation as an 
anodyne and hypnotic. In cholera morbus and diarrhoea this remedy 
has been used successfully, but we now possess more efficient ones. 

Before the days of anassthesia, and in very remote times, the fumes 
of hashish were employed to stupefy and to render painless surgical 
operations. It was also employed to relieve pain, and as a substitute 
for opium in neuralgia, and as an hypnotic. In migraine it has been 
used with decided success by Seguin, Williams, and others. Good re- 
sults have been obtained from it in epilepsy by Sinkler and others, and 
it deserves further consideration in this disease. In chorea, and in 
delirium tremens, it is strongly urged by De Cavaillon, and in senile 
trembling and paralysis agitans it has afforded relief. About one half 
of the cases of tetanus, for which hemp was much prescribed a few 
years ago, got well under its use ; but more accurate knowledge of 
the natural history of this disease has shown that many cases tend to 
recovery without the aid of medicines. 



COCA. 511 

It is well established that hemp has the power to promote uterine 
contractions. It can not initiate them, but increases their energy when 
action has begun. It may be given with ergot. In consequence of 
this power which it possesses to affect the muscular tissue of organic 
life, hemp is used successfully in the treatment of menorrhagia. It is 
said to be especially useful in that form of menorrhagia which occurs 
at the climacteric period (Churchill). It has, more recently, been shown 
to possess the power to arrest haemorrhage from any point, but it is 
chiefly in menorrhagia that much good is accomplished. 

There can be no doubt that cannabis Indica is a useful remedy in 
cases of impotence. It need hardly be stated that it is adapted to the 
functional disorder. It may be advantageously combined with ergot 
and nux vomica in this malady ; for example : $ Ext. cannabis Indi- 
cse, gr. x ; ergotin (aq. ex.), 3ij ; ext. nucis vom., gr. x. M., ft. pil. 
no. xx. Sig. : One morning and evening. 

This agent has also been used with su3cess in the treatment of 
gonorrhoea. It diminishes the local inflammation, allays chordee, and 
lessens the pain and irritation, with the accompanying restlessness. 

Authorities referred to : 

Bulletin General de Titer apeutique. Various articles, 1870, '74, '76. 
Fluckiger and H anbury. Pharmacographia, p. 491. 
Seguin, Dr. E. C. New York Medical Record, vol. xii, p. 774. 
Williams, Dr. S. W. London Medical Record, vol. i, p. 407. 

Erythroxylon. — Coca or cuca. The leaves of Erythroxylon coca 
Lamarck (Nat. Ord. JErythroxylacew). 

Preparation. — Extraction Erythroxyli Fluidum. — Fluid extract 
of erythroxylon. Dose, 3 ss — 3 ij. 

Composition. — The effects of coca, or cuca, depend on the pres- 
ence of a peculiar alkaloid — cocaine. It contains also an aromatic oil 
which gives it the special aroma and taste, and it possesses consider- 
able astringency, due to the presence of a tannic acid. The odor, 
taste, and appearance of the infusion are comparable to those of tea. 
Cocaine has decided basic properties, and combines with acids to form 
salts. It crystallizes in prisms in the smaller rhombic system (Huse- 
mann), which, when pure, are transparent and colorless. It is very 
slightly soluble in water and in alcohol, but dissolves freely in ether. 
It has a bitter taste, and the salts are more bitter than the alkaloid 
itself. 

Antagonists and Incompatibles. — The actions of coca are op- 
posed by all those agents which increase waste. The infusion and 
fluid extract are incompatible with the metallic salts. Muriatic acid 
splits cocaine into benzoic acid and an alkaloid — ecgonine ; hence the 
mineral acids should not be prescribed with the infusion and fluid ex- 
tract. 



512 CEREBRAL EXCITANTS. 

Synergists. — The agents promoting constructive metamorphosis, 
caffeine, the cerebral stimulants, and the narcotics generally, increase 
the effects of coca. 

Physiological Actions. — The historical notes of Sir R. Christi- 
son show that the peculiar properties of cuca-leaves have long been 
known to the inhabitants of Peru. The leaves have a strong, tea-like 
odor, and the infusion resembles ordinary tea in taste. The volatile 
oil and the active principle are readily diffusible, and enter the blood 
with facility. A momentary depression of the pulse and diminution 
of the blood-pressure take place, but these effects are quickly over- 
come, and a considerable increase in the action of the heart and of the 
blood-pressure follows (Ott). A feeling of contentment and of well- 
being takes possession of the mind, the sense of fatigue is removed, 
drowsiness is experienced for a brief period, but it is soon succeeded 
by wakefulness and increased mental activity. It has long been 
known to the mountaineers of the Peruvian Andes that chewing cuca- 
leaves increases the respiratory power, and removes, or lessens, the 
sense of fatigue. The celebrated pedestrian, Weston, having learned 
this fact, was detected in the use of cuca during one of his extraordi- 
nary feats in London (Thompson). 

Although erythroxylon (coca or cuca) had been the subject of in- 
vestigation and its power to suspend the functions of the sensory 
nervous system recognized, the character of its local action was not 
suspected. It was reserved for Dr. Roller, of Vienna, to discover its 
analgesic effects when applied directly to the mucous membrane, and 
this great fact he demonstrated before the Ophthalmological Congress 
at Heidelberg. It happened that the distinguished ophthalmologist 
of New York, Prof. Dr. Noyes, was in attendance on the Congress, 
and he sent to the New York " Medical Record " a letter giving the 
facts of the discovery, and this proved to be the first statement in the 
English language of Roller's demonstration. As the possibilities of 
the future utility of cocaine as a local anaesthetic was then recog- 
nized, it created a profound impression, and in an incredibly short 
time this remarkable discovery became the common interest and the 
common possession. Everywhere cocaine was investigated by physio- 
logical and clinical methods, and the results confirmed the statements 
of Roller. By no one on this side of the ocean was the investigation 
of the properties and powers of cocaine, more especially from the stand- 
point of the ophthalmologist, more carefully conducted than by Rnapp, 
of New York, who confirmed the results attained by Roller. Before 
the Congress of Ophthalmologists Roller exhibited the effect of a four- 
per-cent solution applied to the conjunctiva — such a degree of anaes- 
thesia being induced by it that this delicate membrane bore cutting, 
pinching, and tearing without any manifestation of pain and without 
exciting reflex action. It was also shown that the local action of co- 



COCA. 513 

came included a condition of anaemia of the parts due to an active 
contraction of the arterioles. Only the mucous membrane is rendered 
anaesthetic. The skin is not penetrated unless an abrasion or some 
punctures permit the solution to pass through. Dr. Corning has pro- 
posed to make use of Baunscheidt's needle instrument for puncturing 
the skin and to secure the passage of the fluid through by means 
of galvanism, the negative electrode containing the cocaine solution 
placed over the punctures. The hypodermatic injection of the cocaine 
solution is both more efficient and more easily applied. The area of 
insensibility may be small or large, for its bounds are limited only by 
the amount of fluid administered. 

The character of the action of cocaine is much influenced by the 
amount administered, and the several stages of its action differ be- 
cause the immediate and primary effect is necessarily opposed to the 
condition of reaction which seeks to restore the normal. When a suffi- 
ciently active dose is given, the first effect is stimulation ; the heart- 
beats are accelerated ; the respiration becomes more frequent ; the 
reflexes respond to a distant irritation more promptly ; the mind ex- 
periences a grateful sense of well-being and of activity, and ideation is 
ready, acute, and comprehensive. 

The stage of excitement continues for an hour or two, and is suc- 
ceeded by depression, which is at the same time physical, mental, and 
moral. The pulse may continue quick, but its force declines, and 
some irregularity of the rhythm may occur ; the skin grows moist or 
profuse sweating comes on ; the body temperature declines a little, 
possibly ; the appetite is lost, and nausea and vomiting increase the 
feelings of physical wretchedness and moral distress. These are the 
conditions which impair nutrition. Observations made on those un- 
fortunates addicted to the use of morphine and cocaine have proved 
misleading. The decline in the weight of the body is for the most 
part due to the gastro-intestinal derangement and to the complete 
anorexia which is a result of the withdrawal of the morphine. No 
doubt cocaine contributes to the wasting to some extent. Although 
cocaine is not actively toxic, and may be taken in enormous doses, 
some persons are highly susceptible to its action, and are profoundly 
depressed by a minute quantity. On the one hand, we find that Dr. 
Hammond, who reports taking eighteen grains at a single dose, has 
experienced only disturbed sleep and severe headache as a consequence ; 
on the other hand, a susceptible woman, who is made faint, nauseated, 
and seriously depressed by the minute quantity that has passed into 
the nares from an instillation into the eye. 

In the smaller medicinal doses (^ to J- grain) cocaine stimulates the 

nerve-functions, gives clearness and power to the tones of the voice, 

heightens the reflexes, and raises the arterial tension. Large doses act 

briefly in the stimulating way above described, but the depression 

34 



514 CEREBRAL EXCITANTS. 

stage quickly succeeds, then the mental activity declines, memory is 
impaired, and a sense of weariness comes on. During this period 
there is more or less sweating, sometimes profuse, and a tingling and 
pricking sensation accompany it. 

Cocaine pursues a certain order in its action on the brain and nerv- 
ous system : first the hemispheres, then the lower motor and co-ordi- 
nating centers and the reflex centers, including respiration and also the 
vaso-motor center. The sensory paralysis includes the posterior col- 
umns ; but it is held by the principal authorities that it begins in the 
peripheral nerves, and thence extends to the sensory tract in the spinal 
cord. 

Cocaine first stimulates and afterward paralyzes the pneumogastric 
nerve, and the respiration is first increased and afterward paralyzed, 
failure of respiration being the mode of dying. 

The utility of cocaine was first demonstrated in ophthalmological 
practice. The manner of its action on the eye has been carefully 
worked out as a basis for its therapeutical applications. When in- 
stilled into the eye, anaesthesia is first induced in the conjunctiva and 
cornea, and this effect may be accomplished by a solution having the 
strength of 2 to 100 ; but stronger solutions (5 to 100) act more 
quickly and efficiently. When the deeper parts of the eye are to be 
acted on, the stronger solutions are made use of, and the contact must 
be sufficiently prolonged. Wounds of the eyes and incisions made 
are utilized to secure the diffusion of the anaesthetic to the deeper 
parts of the organ. A simple congestion of the conjunctiva does not 
hinder the effects of cocaine ; but chronic changes in the structures of 
the organ have a retarding influence. Some dilatation of the pupil 
begins in about fifteen minutes after an instillation, but the pupil re- 
mains sensitive to light (Roller). Accommodation is somewhat af- 
fected, but not sufficiently so to be an interference. The mydriasis 
reaches its maximum in about an hour, and subsides in three or four 
hours afterward. 

Cocaine is eliminated by the kidneys and may be detected in the 
urine. The excretion takes place in a short time, in a few hours, and 
hence any effect it has on the organism is not persistent. An impres- 
sion has prevailed that it is specially hurtful ; but this conception of 
its character has developed out of a misconception, as I have already 
stated. The attempts to substitute cocaine in cases of the opium-habit 
can not succeed, and a rapid decline in flesh and strength is because of 
the loss of the support given by opium. Unless an idiosyncrasy ex- 
ists, the moderate use of cocaine seems to be not incompatible with a 
normal degree of bodily and mental vigor. 

Therapy. — The preparations of coca, especially the wine, are much 
employed as stomachic tonics. The consumption of wine of coca (a 
solution of cocaine in wine) must be enormous, for numerous prepara- 



COCA. 515 

tions are on the market. They are advertised in the most lavish 
manner, and so freely dispensed to physicians in the form of trial 
specimens that only large sales with immense profits can justify the 
expenditure. The author has observed that clergymen, and men 
with scruples and high moral character, take this wine freely, and 
not without a devout appreciation of its grateful action in time of 
need. 

To illustrate : a clergyman of character, attainments, and rhetorical 
skill, informed me that he always took a small wine-glassful of the 
wine of coca before his Sunday morning service. He had found that 
it banished fatigue, gave a resonant tone to his voice, and freed his 
intellect from the trammels of a written discourse, and gave scope and 
power to his sermon. Those who at first experienced this grateful 
addition to their resources came after a time to that melancholy stage 
of its action when the dose taken must be larger, and consequently an 
increasing depression with its baleful associations continually succeeds 
to the shortening stage of agreeable excitation. 

In various neuroses of the respiratory organs, asthma, zo hooping- 
cough, singultics, etc., there can be no doubt respecting its curative 
power, and small doses are more useful than large ones in these cases. 
The effects are more decided when the remedy is thrown under the 
skin, and a single dose may give more relief than weeks of other 
treatment. In the case of neurotic individuals with the irritable and 
impressionable nervous system characteristic of the type, cocaine, more 
especially when administered hypodermatically, has acted in a way to 
indicate serious danger. We have already pointed out how it is that 
such an idiosyncrasy may endanger, even take, life by sudden failure 
of respiration or of circulation. 

The topical action of cocaine in hay-fever has proved to be a valu- 
able expedient. The solution, four to ten per cent, in spray or ap- 
plied by the brush to the whole surface of the nasal and faucial mu- 
cous membrane, lessens congestion and secretion, and prevents the 
passage to the respiratory center of the peripheral irritation. Better 
than with a solution the parts affected are easily acted on by the slow 
solution of a compressed pellet placed conveniently in the anterior 
nares behind the cartilages. Numerous reports have been made of the 
complete relief afforded by this mode of application. 

Most remarkable have been the successes obtained by the local ap- 
plications of cocaine to abate inflammation, to stop or to relieve pain. 
It must not be forgotten that swallowing during and immediately 
after local applications to the nares and fauces may cause systemic 
effects. Cases have occurred in which a small quantity thus entering 
the system has brought on the most alarming syncope. The small 
quantity escaping by the tear-duct into the nose, thence into the oesoph- 
agus, has also in a few instances caused faintness. 



516 CEREBRAL EXCITANTS. 

Cocaine is a remedy of the highest value in chorea. The author 
has repeatedly cured cases in which all the ordinary and some ex- 
traordinary remedies had been used in vain. The whole amount given 
daily has rarely exceeded one half a grain. Paralysis agitans, alco- 
holic tremors, and senile trembling, are more favorably affected by 
cocaine than by any other remedy. Large doses and frequent admin- 
istration are unnecessary, and if carefully attended to the special influ- 
ence of the remedy on consciousness need not be developed to a suffi- 
cient extent to form a habit. 

Combined with atropine, cocaine becomes a valuable hypnotic ; for 
example : $ Cocainse hydrochlor., gr. xv ; atropine sulphat., gr. ss. 
M., ft. pil. no. lx. Sig. : One or two at bed-hour. 

The enormous value of cocaine as a local anaesthetic in ophthal- 
mology is fully conceded, and no less useful has it proved to facilitate 
manipulations and to render them painless in laryngological, genito- 
urinary, obstetrical, and gynaecological and rectal surgery. It would 
be a labor of supererogation to enlarge on this topic. It has been suc- 
cessful in a remarkable degree in the treatment of vaginismus, pruri- 
tus, and cutaneous maladies in which itching is the most troublesome 
symptom. The solution used for these purposes should have a strength 
of five to ten per cent. 

Authorities referred to : 

Bouchard at, Prof. Annuaire de Therapeutique, 1876. 

Christison, Sir Robert, The British Medical Journal, April 29, 1876. 

Husemann, Drs. August und Theodor. Die Pjlanzenstoffe, p. 89. 

Ott, Dr. Isaac. Cocaine, Veratria, and Gelsemia. Philadelphia : Lindsay & Blakis- 
ton, 1874. 

Thompson, Mr. J. Ashburton. The British Medical Journal, March 11, 1876, and 
March 18, 1876. 

Caffeina. — Caffeine. A proximate principle of feebly alkaloidal 
power, generally prepared from the dried leaves of Camellia thea Link 
(Nat. Ord. Ternstroemiaceaz), or from the dried seeds of Caffea Arabica 
Linne (Nat. Ord. Bubiacece), or from guarana, and occurring also in 
other plants. 

The source of the caffeine of commerce is, for the most part, in- 
ferior grades of tea. When either theine, so called, or caffeine, is 
called for, from Merck, for example, the same alkaloid — caffeine — is 
supplied. The source of the alkaloid is given in the IT. S. Phar- 
macopoeia as camellia thea. Such a history disposes of those inves- 
tigations which have had for their object the discovery of differ- 
ences between them — for only different specimens of the same alka- 
loid have been examined. 

The salt of caffeine most worthy of consideration is the hydrobro- 
mate. This should not be confounded with certain proprietary com- 
pounds — more truly, mixtures — that consist of caffeine and bromides. 



CAFFEINE. 517 

Some new salts of caffeine have been lately brought forward 
and are probably improvements on those heretofore available. They 
consist of sodio-salicylate, sodio-benzoate, and soclio-cinnamate of caf- 
feine. These are soluble combinations, and can be given subcutane- 
ously without causing local irritation. The dose for stomachal ad- 
ministration ranges from gr. ij to gr. xv. 

JEthoxy '-caffeine is a substitution product of considerable promise 
— ethyl replacing one atom of hydrogen in caffeine. According to 
Dujardin-Beaumetz, this is an excellent hypnotic and calmative. It 
is crystalline, has basic properties, and, although insoluble in water, 
its salts can be dissolved with readiness. The following formula is 
a convenient one for extemporaneous use : ^ Ethoxy-caffeinae, gr. 
iv ; sodii salicylate, gr. iv ; aquse lauro-cerasi, 3 iss ; syrupi, J ss. M. 
Sig. : A tablespoonful as required. The addition of one and a half 
grain of cocaine is recommended by Dujardin-Beaumetz to increase 
its hypnotic action. 

The so-called " citrate of caffeine " is not a chemical combination, 
but a mere mixture, and hence some of the combinations mentioned 
above should be substituted for it. 

Properties. — Caffeine crystallizes in needle-shaped crystals and 
in prisms. It is bitter in taste, soluble in water and in alcohol. It is 
remarkable for the quantity of nitrogen it contains, surpassing in this 
respect all other alkaloids. 

Caffeine in small quantity acts as a stomachic tonic, and rather 
improves than lessens appetite when administered in diseased states. 
It is feebly laxative, owing probably to its action in stimulating the 
glands of the mucous membrane, thus increasing secretion. 

The most important function is its action on the heart and circu- 
lation. We owe more especially to Dr. Hu chard and Professor See 
the modern experience in regard to its place as a cardiac remedy. It 
has not, until recently, been given in quantity sufficient to produce 
the appropriate effects, and until recently its powers as a substitute 
for digitalis were not appreciated. For making a satisfactory im- 
pression on the organs of circulation not less than five grains at a 
dose, and fifteen to twenty grains in twenty-four hours, are required. 
In sufficient quantity caffeine slows the heart, lengthens the interval, 
and increases the power of the muscular contraction. It also raises 
somewhat the arterial tension by stimulating contraction of the arte- 
rioles, and it has distinct and available diuretic property. Excessive 
and too frequent administration of caffeine will bring on toxic effects, 
in which the heart becomes weak and irregular, the pressure falls, 
and respiration fails, death being due to paralysis of the respiratory 
muscles. 

As regards the action of caffeine on the brain, it may be stated 
that, at first, drowsiness occurs ; but this is soon followed by wakeful- 






518 • CEREBRAL EXCITANTS. 

ness, excitement, muscular trembling, confusion of mind, hallucina- 
tions, and delirium. The cerebral effects terminate in deep sopor, but 
this is probably the result of exhaustion. Rise of temperature, con- 
vulsions, general paralysis, occur when toxic doses are administered 
to animals ; but the temperature declines when paralysis supervenes 
(Leven, Schmiedeberg, Bennett, and others). 

Therapy. — Caffeine is a useful stomachic tonic. In convalescence 
from acute maladies it is in a high degree serviceable, given to pro- 
mote the constructive metamorphosis. Chronic catarrh of the stomach, 
with occasional attacks of migraine, is a combination of maladies in 
which caffeine is especially useful. Paullinia, or cuca, may be used 
instead. 

In the diarrhoea of phthisis, in ordinary atonic diarrhoea, in cholera 
infantum, and in cholera morbus, produced by agencies affecting the 
nervous system, the remedies of this group, especially caffeine, are 
often extremely useful. When the vital powers are depressed, and 
when there is at the same time an abnormal excretion of urea — a 
condition of things which exists in incipient phthisis, associated with 
indigestion — caffeine, cuca, and paullinia are in a high degree service- 
able. They increase the appetite and the digestive power, and dimin- 
ish tissue-waste. 

Black coffee, or caffeine, increases the action of the heart and raises 
the arterial tension, and is therefore useful when the circulation is de- 
pressed from various causes. 

An important use of caffeine, at present, is in the treatment of head- 
ache. It is adapted especially to the relief of migraine, the so-called 
nervous headache, accompanied with or without stomach-derangement. 
In this disorder we may administer a grain of caffeine every half -hour, 
until the headache is relieved ; or the bromhydrate of caffeine may be 
given in an effervescent draught. Yery elegant preparations are the 
granular, effervescent preparations of caffeine. 

Caffeine has proved very useful in cardiac dropsy ; and in renal 
dropsy in inverse ratio to the amount of damage suffered by the kid- 
neys, for, as Brackenridge has shown, this remedy does not increase 
the flow of urine when the renal epithelium is destroyed. It may be 
used with advantage in ascites when any diuretic will prove service- 
able. It has, within the past two years, been much employed by the 
French therapeutists, in place of digitalis, in the treatment of certain 
cardiac affections. According to Huchard, caffeine acts more rapidly 
than digitalis, causing free diuresis in twenty-four hours. It slows 
the pulse and raises the arterial tension, thus effecting a better distri- 
bution of the blood. To bring about these desirable effects, Huchard 
rapidly increases the dose, so that on the third day he gives a gramme 
(15| grs.) hypodermatically. 

The author can confirm the observations of Dr. Huchard, bv his 



COCAINE COMBINATIONS. 519 

own experience in the use of caffeine in cases of mitral incompetence 
with general dropsy. Having the same kind of action on the heart, 
not cumulative, and unirritating as digitalis, he has obtained as good 
results, and with far less discomfort to the patient, with caffeine. 

COMBINATIONS— ANTAGONISTIC AND SYNERGISTIC— OF COCAINE. 

With Atropine. — Attention was called to the actions of atropine and 
cocaine at the time an attempt was made to float into prominence a 
fraudulent remedy composed of a mixture of the two. As the ac- 
tions of the supposed new remedy were studied by some who are emi- 
nently qualified for the task, and as new facts were thus ascertained, 
it is clear that sufficient merit was found in the combination to justify 
some notice of it here in this form. 

Actions and Uses. — A two-per-cent solution of the compound 
applied to the conjunctiva, or mucous membrane of any part, induces 
anaesthesia in about five minutes. If applied to the conjunctiva, the 
anaesthesia is accompanied by a mydriasis of the maximum extent, the 
dilatation beginning in ten to fifteen minutes, and reaching its greatest 
extent in twenty minutes, but remaining in that condition for twelve 
to twenty-four hours, and not entirely disappearing for three days. 
The accommodative apparatus is acted on quite vigorously, becomes 
paretic in ten to fifteen minutes, and completely paralyzed within a 
half -hour. The anaesthetic effect is induced when the solution is ap- 
plied to the mucous membrane in any situation — the fauces, nares, 
urethra, etc. In some subjects such a degree of susceptibility to its 
action exists that the absorption of a minute quantity causes nausea, 
pallor, vertigo, and rapid action of the heart. In this respect, as in 
the anaesthetic action, it more resembles cocaine : in its mydriatic 
action and paralyzing effect on the accommodative apparatus more 
atropine. In the rapidity of the action on the pupil, in the degree 
of dilatation, and in the persistency of the mydriatic effects, it has 
more the action of atropine, but is more powerful and also more 
enduring. 

Injected subcutaneously, very soon convulsions of a tetanic char- 
acter are produced ; trembling precedes the tonic spasms, and occurs 
also between them, while paresis, quickly passing into paralysis, re- 
sults from the exhaustion of over-stimulation. In respect to the 
behavior of the tetanic convulsions, they more resemble those of 
picrotoxin than of strychnine. 

When the mixture was first brought forward it was asserted that 
it affected cutaneous sensibility in the same way that it does that of 
the mucous membranes. Knapp was unable to verify this observa- 
tion, and such a claim has not been made since. 

The therapeutical applications of the combination can be deduced 
from the physiological actions. Thus far the course of the investiga- 



520 CEREBRAL EXCITANTS. 

tions has been limited to the uses of the new mixture in ophthalmic 
practice ; but indications are thus furnished to guide its applications 
in diseases in general. 

The conclusions of Knapp, based on Dr. Claiborne's and his own 
observations, are as follows : 

In cases of iritis, the combination of cocaine and atropine is supe- 
rior to cocaine alone, and should also be preferred to atropine alone 
when pain is suffered, and when a tendency to glaucoma exists. On 
the other hand, when the mydriasis is an objection — as in the case of 
most of the operations on the eye — cocaine should be preferred. 
When paralysis of the accommodative apparatus is desirable, the 
compound acts as efficiently as atropine, and is preferable, because its 
effect is shorter in duration. 

Small doses, rapidly absorbed, may cause, as does cocaine, some 
general disturbance, which consists in sudden pallor, cold sweats, 
vertigo, stupor, faintness, etc., and large doses, approaching lethal in 
strength, bring on tetanic spasms, trembling, rapid action of the heart, 
and failure of respiration. 

Inducing complete anaesthesia of the mucous membrane at any 
point, surgical procedures of all kinds may be carried on without any 
sensation of uneasiness. In all of the morbid states in which cocaine 
has hitherto been used alone, the combination may be substituted, 
unless the dilatation of the pupil constitute an objection. 

With Chloral and Urethan. — It has long been known that chloral 
has the power to liquefy various agents, as camphor, urethan, and 
others. The combination of chloral and urethan being affected, co- 
caine will dissolve in it to any desirable extent. Thus : ^ Chloral, 
hyd. ; urethan, aa, 3 ij. M. Solve. To the solution add cocain. 
hydrochlorat. gr. ij vel g. iv. M. Dose ^l x — ni xx vel. 3 ss. As this 
will mix with water without separating, it becomes a convenient and 
powerful anodyne and anaesthetic. 

Under the name Uralia this preparation has been brought forward 
recently as new, and extravagant praise given it as an anodyne. 

Guarana. — A dried paste, prepared from the crushed or ground 
seeds of Paullinia sorbilis Martius (Nat. Ord. Sapindacece). 

Extractum Guarance Fhddum. — Fluid extract of guarana. Dose, 
m x — 3 ij. 

Composition. — It contains a principle which has been entitled 
guara?iine, and which subsequent researches have proved to be iden- 
tical with caffeine. 

Actions and Uses. — The physiological effects of paullinia are 
due to its alkaloid, chiefly ; and, as this is the same as caffeine, the 
observations already made on the latter are equally applicable to the 



ALCOHOL. 521 

former. One instance has come under the author's observation, in 
which the use of guarana had become a habit. Every morning the 
lady took a considerable dose of the paste before appearing to the 
world. Quite a serious effort was required to wean her from it. As 
is the usual result, the accustomed stimulus withdrawn, digestion and 
assimilation became feeble, and loss of flesh occurred ; but, after re- 
covery, all was regained that had been lost. 

The special use of paullinia is in the treatment of sick-headache 
or migraine. It is adapted to the so-called nervous form of sick- 
headache, and is less efficient when the attacks are due to stomachal 
troubles. As it possesses, directly or indirectly, restorative powers, it 
may be employed to promote constructive metamorphosis. Adminis- 
tered with this view, it may be given with advantage in the conva- 
lescence from acute maladies, in incipient phthisis ', and in the toasting 
diseases generally. 

Authorities referred to : 

Amory, Dr. R. Boston Medical and Surgial Journal, 1868, p. 17. 

Aubert, M. Physiological Action of Caffeine. Centralblatt, 1873, p. 124. 

Bennett, Dr. Alexander. Physiological Actions of Theine, Caffeine, Guaranine, 
Cocaine, and Theobromine. Pamphlet, 1873. 

Huchard, Dr. Henri. Be la Cafeine dans les Affections du Coiur. Journal de TJiera- 
peutic, September 10, 1882. 

Leyen, M. Archiv de Physiologie, 1868, pp. 179, 470. 

Pratt, Dr. Boston Medical and Surgical Journal, vol. ii, 1868, p. 6. 

Schmiedeberg, Prof. 0. Ueber die Verschiedenheit der Caffeinivirkung an Rana tern- 
poraria L. und Rana esculenta L. Arch. f. exper. Path. u. Phar., 1874, p. 63. 



REMEDIES WHICH DIMINISH OR SUSPEND THE 
FUNCTIONS OF THE CEREBRUM AFTER A PRE- 
LIMINARY STAGE OF EXCITEMENT. 

To this group belong the so-called narcotics, the anaesthetics, and 
some of those usually classed as antispasmodics. They all agree in 
these respects : their effects are expended, chiefly, on the nervous sys- 
tem ; they first stimulate the functions of the brain, but this stage of 
excitement, which may be of shorter or longer duration, is followed by 
sopor, coma, and complete insensibility. 

Alcohol. — Alcohol. A liquid composed of 91 per cent by weight 
(94 per cent by volume) of ethyl alcohol, and 9 per cent by weight (6 
per cent by volume) of water. Specific gravity, 0*820 at 60° Fahr. 
A transparent, colorless, mobile, and volatile liquid of a characteristic, 
pungent, and agreeable odor, and a burning taste. 

Alcohol Dilutum. — Diluted alcohol. A liquid composed of 45*5 
per cent by weight (53 per cent by volume) of ethyl alcohol, and 54*5 
per cent by weight (47 per cent by volume) of water. Specific gravitjj 



522 CEREBRAL SEDATIVES. 

0-928 at 60° Fahr. Alcohol, 50 parts; distilled water, 50 parts. 
(U.S. P.) 

Alcohol Amylicum. — Amylic alcohol. Fusel-oil. 

A peculiar alcohol, obtained from fermented grain or potatoes, 
by continuing the process of distillation after the ordinary spirit has 
ceased to come over. An oily, nearly colorless liquid, having a strong, 
offensive odor, and an acrid, burning taste. Its specific gravity is 
0*818, and its boiling-point between 268° and 272°. It is sparingly 
soluble in water, but unites in all proportions with alcohol and ether. 
It does not take fire by contact with flame, and, when dropped on 
paper, does not leave a permanent greasy stain. Exposed to the air in 
contact with platinum-black, it is slowly oxidized and yields valerianic 
acid. (U. S. P., 1870.) 

. Sjriritits Frumenti. — Whisky. An alcoholic liquid, obtained by 
the distillation of fermented grain (usually corn, wheat, or rye), and 
at least two years old. 

Whisky has an amber color, a distinctive taste and odor, and a 
specific gravity not above 0*930 nor below 0*917, corresponding ap- 
proximately with an alcoholic strength of 44 to 50 per cent by weight, 
or 50 to 58 per cent by volume. 

Spiritus Vini Gallici. — Brandy. An alcoholic liquid obtained 
by the distillation of fermented grapes, and at least four years old. 

Brandy has a pale, amber color, a distinctive taste and odor, and a 
specific gravity not above 0*941 nor below 0*925, corresponding ap- 
proximately with an alcoholic strength of 39 to 47 per cent by weight, 
or 45 to 55 per cent by volume. 

Composition. — A large number of bodies have been classed under 
the generic term of alcohols. A list of the most important of these is 
subjoined : 

Methylic alcohol CH 4 0. 

Ethylic " C 2 H 6 or CH 4 + (CH 3 ). 

Propylic " C 3 H g O or CH 4 0^-2(CH 2 ). 

Butylic " C 4 H 10 O or CH 4 + 3(CH 2 ). 

Amylic " C 5 H 12 or CH 4 + 4(CH 2 ). 

Caproic " C 6 H 14 or CH 4 + 5(CH a ). 

These alcohols are called " homologous," because they are closely 
related to each other, and differ by the common multiple CH Q . Ethylic 
is the common or ordinary alcohol, and amylic is an impurity existing 
in certain alcoholic beverages — for example, whisky, in which it oc- 
curs in consequence of the cupidity of distillers in carrying on the 
process after all the ethylic alcohol has distilled over. Absolute alco- 
hol should be entirely free from any odor except its native ethereal 
odor, and no products but carbonic acid and water should result from 
its combustion. 

Whisky is a solution of alcohol in water (48 to 56 per cent), but 



ALCOHOL. 523 

contains various odorous principles and ethers which impart to it its 
peculiar physical properties. The best specimens, doubtless, contain 
traces of fusel-oil, and acetic, butyric, and sometimes valerianic acids 
are present in it. The reactions of these acids with the alcohol result 
in the formation of various ethers, and hence old whisky is more fra- 
grant, and therefore more highly prized, than the recent product of 
the still. 

Brandy is also a solution of alcohol in water (48 to 56 per cent). 
It has a wine-like odor, and a hot, astringent taste. It contains a 
volatile oil, an ether peculiar to wines (oenanthic ether), coloring-mat- 
ters, tannic acid, aldehyde, and acetic ether. The color is usually fac- 
titious : in pale brandy ', the color is derived from the cask ; in dark 
brayidy, from caramel. Brandy is made artificially from high-wines 
by the addition of an ether (cognac, acetic or nitric), of coloring- 
matter (burnt sugar), and an astringent to give it the necessary rough- 
ness of taste (logwood, catechu, etc.). 

Physiological Actions. — Alcohol in prolonged contact with the 
skin, evaporation being prevented, excites a sense of heat and super- 
ficial inflammation. It coagulates albumen and hardens the animal 
textures. The epithelium of the mouth is corrugated by it — a result 
due to the abstraction of water and condensation of the albumen. In 
the stomach alcohol causes a sense of warmth, which diffuses over the 
abdomen, and is quickly followed by a general glow of the body. In 
moderate quantity it induces a superficial congestion of the mucous 
membrane — a dilatation of the arterioles — and this increased blood- 
supply enables the mucous follicles and the gastric glands to produce 
a more abundant secretion. The increased formation of the stomach- 
juices is doubtless somewhat determined by the stimulation of the 
mouths of the glands, in accordance with a well-known physiological 
law. The excitation of the gastric mucous membrane, when habitual, 
results in important changes ; a gastric catarrh is established — for the 
mucous follicles, under the influence of repeated stimulation, pour 
forth a pathological secretion- The gastric glands at first simply pro- 
duce an increased amount of gastric juice, but abnormal stimulation 
results in pathological changes in this secretion. The increased blood- 
supply to the mucous membrane sets up an irritation of the connective 
tissue, which undergoes hyperplasia ; the proper secreting structure 
is encroached upon, and the glands suffer atrophic changes which re- 
sult in still more important modifications of the gastric juice. Alco- 
hol also affects directly the constitution of the gastric juice by precipi- 
tating the pepsin from its solution and by arresting the activity of this 
ferment. 

In small doses, not too frequently repeated, alcohol increases the 
digestive power by stimulating the flow of blood and soliciting a 
greater supply of the stomach-juices. Large doses impair digestion 






524 CEREBRAL SEDATIVES. 

directly by precipitating the pepsin, an albuminoid ferment. That a 
small quantity does not produce the same results in a comparative de- 
gree, is simply due to the fact that it is too far diluted, by the quan- 
tity of fluid present in the stomach, to act on the pepsin. 

The structural alterations induced by the habitual use of alcohol, 
and the action of this agent on the pepsin, seriously impair the diges- 
tive power. Hence it is that those who are habitual consumers of 
alcoholic fluids suffer from disorders of digestion — gastric catarrh. The 
abnormal mucus which is elaborated in great quantity, acts the part of 
a ferment, and the starchy, saccharine, and fatty elements of the food 
undergo the acetic, lactic, and butyric fermentations. Acidity, heart- 
burn, pyrosis, regurgitation of food, and a peculiar retching in the 
morning (morning vomiting of drunkards), are produced. 

As alcohol is a very diffusible substance, it enters the blood with 
great facility, and probably almost all of that taken into the stomach 
passes into the blood from this organ, and does not reach the small 
intestine. The liver is consequently the first organ, after the stomach, 
to be influenced by the ingested alcohol. The blood of the portal 
vein, rendered more highly stimulating by the presence of alcohol, in- 
creases for the time being the functional activity of the liver-cells, 
and, as is the case with the stomach, a more abundant glandular secre- 
tion follows. Frequent stimulation and consequent over-action result 
in impairment or loss of the proper function of the part, as is the uni- 
versal law. The hepatic cells, over-stimulated, produce an imperfect 
product ; they are affected by fatty and atrophic changes, and shrink 
in size ; and the connective tissue of the liver undergoes hyperplasia. 
The first result of the structural alterations is an increase in the size 
of the organ ; but with the shrinking of the hepatic cells, and the con- 
traction of the newly-formed connective tissue, the liver becomes 
smaller, nodulated, and hardened. To this change the term cirrhosis 
has been applied. It is essentially a slowly-developing and chronic 
malady, and long indulgence in alcoholic liquids is necessary to its pro- 
duction. 

In small doses, alcohol increases the action of the heart and the 
cutaneous circulation ; a slight general rise of temperature is observed ; 
and all of the functions are, for the time being, more energetically 
performed. If a considerable dose be taken, the phenomena of exhila- 
ration, of excitement, of slight intoxication ensue. A still larger quan- 
tity causes loss of muscular power, impaired co-ordination of voluntary 
movements, and rambling incoherence. When a toxic dose is taken, the 
stage of excitement is of short duration ; profound insensibility, with 
stertorous breathing and complete muscular resolution, quickly follow. 

As respects the action of alcohol on the nervous system, it is ob- 
vious that its first effect is to increase the functional activity of the 
Drain ; the ideas flow more easily, the senses are more acute, the muscu- 



ALCOHOL. 525 

lar movements are more active. These effects are coincident with the 
increased action of the heart, the slight rise of temperature, and the 
greater activity of the functions of the organism in general. With 
the increased action of the alcohol on the cerebrum the excitement 
becomes disorderly, the ideas incoherent and rambling, the muscular 
movements uncontrolled and inco-ordinate (over-stimulation of the 
cells of the gray matter). With an excessive quantity, the functions 
of the cerebrum are suspended, and complete unconsciousness ensues ; 
the reflex movements cease ; the functions of organic life are performed 
feebly ; and, by an extension of the toxic influence to the centers pre- 
siding over these movements, respiration and circulation are finally 
arrested. 

That these effects on the intra-cranial organs are due to the direct 
action of the alcohol has been shown. Alcohol has been discovered in 
the fluid contained in the ventricles, and has been distilled from the 
cerebral matter ; and Hammond has demonstrated that it has a special 
affinity for nervous matter, being found in the cerebro-spinal axis and 
in the nerves, in greater quantity than in other tissues of the body. 
As a result of the direct contact, chiefly, but in part also from the va- 
riations in the intra-cranial blood-current, important structural altera- 
tions are gradually wrought in the cerebral matter. The cells of the 
gray matter become more or less fatty and shrunken, the neuroglia 
undergoes hyperplasia, shrinking and condensation of the whole cere- 
brum ensue (sclerosis), and the cerebro-spinal fluid relatively increases. 
The objective evidences of these pathological changes are seen in the 
impaired mental power, the muscular trembling, the shambling gait, of 
the drunkard. 

In some subjects from sudden excess of a periodical kind, in others 
from a failure of the stomach to dispose, not only of aliment, but of 
the accustomed stimulus, a peculiar morbid state, known as delirium 
tremens, is produced. Peculiarity of the nervous system — idiosyncra- 
sy — is an important factor in the causation of this condition, and 
probably also the use of alcoholic beverages rich in fusel-oil — for Rich- 
ardson has shown, and the author has repeatedly confirmed the obser- 
vation, that amylic alcohol causes tremors and muscular twitching 
" identical with the tremors observed in the human subject during the 
alcoholic disease known as delirium tremens." 

The long-continued action of alcohol on the nervous system pro- 
duces other disorders besides delirium tremens. Hemi-anaesthesia, 
epilepsy, paraplegia, amaurosis, etc., have been observed to result from 
alcoholic excess, and mental alienation, as the asylum statistics prove, 
has in the same agent its most influential cause. 

It is necessary now to consider what becomes of the alcohol after 
its introduction into the human body, and the influence which it exerts, 
if any, in the metamorphosis of tissue. The results of experiment on 



526 CEREBRAL SEDATIVES. 

these points have been remarkably contradictory ; and the questions 
involved are by no means settled. It would require a volume to make 
a satisfactory analysis of the various memoirs and papers which have 
been published on the actions of alcohol. The author, therefore, 
merely presents the conclusions to which he himself has come, after a 
careful consideration of all the more important contributions to the 
literature of the subject. 

A small quantity of alcohol, in a subject not accustomed to its use, 
causes, as has been already stated, increased activity in all the bodily 
functions, and slight elevation of temperature. Habit, as is the case 
with a great many drugs, modifies in a remarkable manner the physio- 
logical activity of alcohol, and hence these results are not perceived in 
the habitual consumers of this substance. Considerable doses of alco- 
hol cause a decline in the temperature of the body, which is even more 
marked in pyrexia than in the normal state. As respects this effect, 
the influence of habit is equally great, for in old topers a decline in 
temperature does not follow the use of alcohol in doses short of lethal. 
In animals the reduction of the body-heat is more marked than in 
man. To what cause is the decline in temperature, produced by alco- 
hol, attributable ? This is, doubtless, referable to the diminished rate 
of tissue metamorphosis — for it has been ascertained that the excretion 
both of urea and of carbonic acid is lessened by alcohol. The combus- 
tion of the nitrogen and carbon foods is, therefore, retarded. This 
action is represented, objectively, by an increase in the body-weight 
and the embonpoint of those who take stimulants moderately. 

The disposition of alcohol in the organism is a subject which has 
gone through several revolutions of opinion. At present the weight of 
authority and the deductions of experiment are in favor of that view 
which maintains that, within certain limits (one ounce to one and a 
half ounce of absolute alcohol to a healthy man), alcohol is oxidized 
and destroyed in the organism, and yields up force which is applied as 
nervous, muscular, and gland force. The amount of alcohol ingested, 
in excess of this oxidizing power of the organism, is eliminated as alco- 
hol by the various channels of excretion — by the lungs, skin, kidneys, 
etc. As alcohol checks tissue metamorphosis, and thus diminishes the 
evolution of heat and force, it might be expected that the products of 
its own oxidation would supply the deficiency, but this is not the case. 
Alcohol is a useful food in the small quantity which increases but 
does not impair digestion, which quickens the circulation and gland 
secretion but does not over-stimulate, and which is within the limit of 
the power of the organism to dispose of by the oxidation processes. 
This amount has been pretty accurately shown, as stated above, to be 
one ounce to one ounce and a half of absolute alcohol for a healthy 
adult in twenty-four hours. All excess is injurious. North -pole 
voyages, military expeditions (experiences in India and the Ashantee 






ALCOHOL. 527 

march), and the diminished power of resistance to cold shown by- 
drunkards, have conclusively demonstrated that alcohol does not sup- 
ply the place of other foods ; and that those habituated to its use, 
damaged as they are in their vital organs, do not possess the same 
endurance of fatigue and the same power of resistance to external 
morbific influences as do the healthy. Furthermore, clinical expe- 
rience has amply proved that topers do not bear chloroform well, that 
they succumb more quickly to injuries and surgical operations, and 
that they possess much less power of resistance than the temperate to 
the inroads of acute diseases. While these facts rest upon the soundest 
basis, it is equally true that alcohol is, within certain limits, a food, and 
that the organism may subsist, for a variable period, on it exclusively. 

It is an important clinical fact that the physiological effects of alco- 
hol differ in different conditions of the system. In convalescence from 
acute diseases, in the sudden depression of the powers of life caused by 
the bites of venomous snakes, or from loss of blood, or from serious 
injury, quantities which would, in the state of health, cause profound 
intoxication, are taken with impunity. The extremes of life — infancy 
and old age — bear considerable quantities of alcohol well, and are often 
remarkably benefited by them. Habitual use modifies still more de- 
cidedly the immediate influence of this agent on the functions of calor- 
ification, of circulation, and of the nervous system. 

The differential diagnosis of acute alcoholism (lethal dose), of opium 
narcosis, concussion of the brain, cerebral haemorrhage, and haemor- 
rhage into the pons or medulla, is by no means easy. In the absence 
of the history, in any given case, it may be impossible to determine. 
The odor of the breath (of opium or alcohol) ; the state of the pupil 
(contracted from opium, unequal, or contracted or dilated from intra- 
cranial haemorrhage, contracted or dilated from alcoholic intoxica- 
tion) ; the muscular resolution (common to all these states) ; the slow, 
sighing, irregular, or stertorous respiration (may occur in either) ; the 
abolition of reflex movements (a final symptom in all), are in the nature 
of things fallacious. A man who has received a concussion of the brain, 
or had an intra-cranial haemorrhage, may have taken opium or alcoholic 
stimulants in quantity sufficient to impart a distinct odor to his breath, 
without otherwise being distinctly affected by it. The other signs are 
not sufficient in themselves to enable a decision to be reached. Hence 
the importance of an attentive examination of the surrounding circum- 
stances. In the absence of a trustworthy history, it were better to 
suspend opinion until the further developments of the case enable an 
exact diagnosis to be made. The numerous examples of errors fallen 
into by most competent observers should make the physician hesitate 
before pronouncing an opinion of "drunk" or "dying," in the sensa- 
tional language by which some of these cases of mistake have been 
characterized. 



528 CEREBRAL SEDATIVES. 

The treatment of acute alcoholism consists in the evacuation of 
the stomach by the stomach-pump of any unabsorbed alcohol ; the 
cautious inhalation of ammoniacal gas ; cold affusion to the head ; 
faradism of the muscles of respiration, external warmth, etc. 

As respects the post-mortem appearances the following have been 
observed : intense hyperemia of the gastric mucous membrane ; dis- 
tention of the right cavities of the heart, and of the great venous 
trunks ; hyperemia of the cerebral meninges, and serous effusion into 
the ventricles and subarachnoid spaces. 

Theeapy. — Alcohol in small doses is a useful stomachic tonic. It 
is best taken for this purpose after or with meals. It is specially ser- 
viceable in the feeble digestion of old people, the atonic dyspepsia of 
the sedentary, a?id in the slow and inefficient digestion of convales- 
cence from acute diseases. It should be prescribed with caution in 
these cases, especially in the atonic dyspepsia of women and of seden- 
tary men, because of the danger that an alcohol habit may be formed. 
When it is prescribed in the convalescence of acute diseases, the stimu- 
lant should be withdrawn at the earliest period. 

Excellent results are obtained from the use of brandy in the apep- 
sia of infants. The summer diarrhoea, both of children and adults, 
may be arrested by a full dose of brandy. Irritating matters and un- 
digested food should be removed before the brandy is administered. 
The vomiting of cholera-morbus and of cholera may, frequently, be 
arrested by small doses of iced brandy (a teaspoonful in pounded ice 
every half -hour), or tablespoonful doses of iced champagne. Other 
forms of vomiting, when due to irritation or inflammation of the 
stomach — as, for example, the vomiting of pregnancy — can sometimes 
be promptly cured by the same remedy. It not unfrequently happens 
that, in delirium tremens, nothing is retained by the stomach, and the 
life of the patient is put into imminent danger, by reason of the failure 
of the food-supply to the blood. A little brandy and ice will some- 
times settle the stomach under these circumstances, and enable the 
patient to take and digest the much-needed aliment. 

Notwithstanding the theoretical objections which may be urged 
against this practice, clinical experience is strongly in favor of the use 
of alcoholic stimulants to counteract the depressing influence of certain 
agents on the action of the heart — as, for example, aconite, veratrum 
viride, conium, digitalis, and the poison of venomous snakes. Before 
commencing the inhalation of chloroform, an ounce or two of whisky 
or brandy should be given the patient. This serves a double purpose : 
it sustains the heart and prolongs the chloroform narcosis. 

Alcohol in some form is constantly prescribed in low conditions in 
fevers, acute inflammations, and depressing maladies of all hinds. It 
is serviceable in these diseases when it lessens the pulse rate, but in- 
creases the contractile power of the heart and elevates the arterial 



ALCOHOL. 529 

tension. It does harm when the pulse becomes more rapid and the 
blood-pressure is lowered by it. It does good when the tongue, be- 
fore dry, becomes moister under its use, and harm when the dryness 
of the tongue is increased. It does good when the temperature is re- 
duced, the delirium and subsultus lessened, and the sleep becomes 
more continuous and refreshing ; and does harm when it increases 
fever, exaggerates the delirium, and induces coma vigil. The chief 
utility of alcohol in these forms of disease is not as a stimulant, but 
as a food. It furnishes material, easily oxidizable, which can be ap- 
plied as nervous, muscular, and gland force. Furthermore it stimulates 
digestion, and enables more food to be taken and disposed of, and 
thus contributes indirectly to the maintenance of the powers of life. 
It follows from these considerations, that alcohol should be given in 
these low conditions of the organism, with milk, eggs, broth, and 
other suitable aliment. 

Undoubtedly the stimulant treatment of adynamic states is often 
carried to great excess. The large doses of alcoholic substances ad- 
ministered, disorder the stomach and suspend digestion ; and thus the 
condition of things which they are intended to relieve is only made 
worse. Furthermore, stimulants are excessively used in these disor- 
ders, from a wrong notion of their therapeutic action, and a conviction 
that diseases characterized by depression are best treated by arterial 
stimulants. The reaction which has set in against the antiphlogistic 
methods is in part answerable for the great freedom with which alco- 
hol is now used in fevers and inflammations. 

As respects its action on the nervous system, alcohol is a narcotic. 
It may be used to relieve pain, to promote sleep, and to quiet delirium. 
The various neuralgias, may be temporarily alleviated by intoxicating 
doses of alcohol, but such a prescription is dangerous to the moral 
health of the patient. The subjects of neuralgia, or those who 
possess the neurotic temperament, have as a rule an inherited or 
acquired weakness of constitution, and a mobility of the nervous 
system, which render the effects of alcoholic stimulants peculiarly 
grateful. 

When wakefulness is due to a condition of cerebral anwmia, a full 
dose of some alcoholic fluid, whisky or brandy, will procure sound 
and refreshing sleep. In some subjects a glass of ale or beer answers 
better. Some cases of delirium tremens are greatly benefited by alco- 
holic stimulants. When the delirium is the result of sudden excess 
and of the direct action of the alcohol on the cells of the gray matter, 
the use of this agent will only add to the existing disorder ; but when, 
as is so frequently the case, the attack is determined by the failure of 
the stomach to appropriate not only the stimulant but the food also, 
the careful administration of alcoholic stimulants with suitable aliment 
renders an incontestable service. 
35 



530 CEREBRAL SEDATIVES. 

As alcohol stops waste, promotes constructive metamorphosis by- 
increasing the appetite and the digestive power, and favors the depo- 
sition of fat, it is directly indicated in chronic wasting diseases, espe- 
cially in phthisis. Clinical experience is in accord with physiological 
data : alcohol is an important remedy in the various forms of pulmo- 
nary phthisis. It is frequently given with cod-liver oil, or an ounce 
or two of whisky may be taken with some bitter or aromatic imme- 
diately after meals. If alcohol disagrees, if it does not improve but 
lessens the appetite, it will do harm in phthisis. It is an interesting 
fact that an intractable form of phthisis is induced by alcoholic excess. 

External Applications of Alcohol. — Equal parts of alcohol and 
water is an excellent evaporating lotion for the relief of superficial in- 
flammations — bruises, inflamed joints, orchitis, etc. Alcohol is an ex- 
cellent hemostatic for restraining oozing from a large surface. For 
suppurating wounds alcohol is an efficient antiseptic dressing — it de- 
stroys germs, removes fetor, and stimulates the tissues to more healthy- 
growth. It favors the cicatrization of open wounds by coagulating 
the albumen and thus making an impermeable covering. It is a useful 
practice to wash the parts threatened with bed-sores with whisky or 
alcohol ; it hardens the cuticle, and prevents ulceration. Sore nipples 
may be prevented by washing them with brandy after the child nurses, 
and then dusting them with bismuth carbonate. Brandy-and-water is 
an excellent lotion for mercurial and other forms of stomatitis requir- 
ing stimulant applications. Brandy-and-water is one of the thousand 
injections used in gonorrhoea. 

Authorities referred to : 

Anstie, Dr. Francis E. Stimulants and Narcotics, and various papers in The Prac~ 
titioner. 

Baer, Dr. A. Der Alcoholismus, seine Yerbreitung und seine Wirkung, etc. Berlin, 
1878, A. Hirschwald, pp. 621. 

Binz, Prof. Dr. C. Virchow's Archiv, vol. li, p. 153. 

Ibid. The Practitioner, vol. iii, 1869, and vol. v, 1870. 

Dupre, A., Ph. D. The Practitioner, vol. viii, pp. 148, 224. The Elimination of 
Alcohol. 

Jones, Dr. C. Handfield. The Practitioner, vol. vii, p. 331. 

Lallemand, Perrin et Duroy. Du Pole de VAlcobl et des Anmthetiques dans V Or- 
ganisme, Paris, 1860. 

Lombard, Dr. J. S. New York Medical Journal, June, 1S65. 

Murchison, Dr. Charles. A Treatise on Fevers, second edition, p. 230. 

Nicol, Dr. Patrick. TJie British and Foreign Medico- Chirurgical Review, vol. 1, 
p. 203. 

Parkes, Dr. E. A., and Count Cip. Wollowicz. Experiments on the Effects of Alco- 
hol (ethyl alcohol) on the Human Body. 

Rabow, Dr. S. Berliner klinische Wochenschrift. Beobachtungen uber die Wirkung 
des Alkohol auf die Korpcrtemperatur, 1871, p. 257, et seq. 

Richardson, Dr. B. W. The Medical Times and Gazette, December 18, 1869, p. 70S. 

Ringer and Rikard. The Lancet, August 26, 1866, p. 208. 



WINE. 531 

Vinum. — Wine. 

Vinum Album. — White wine. A pale, amber-colored or straw- 
colored alcoholic liquid, made by fermenting the unmodified juice of 
the grape, freed from seeds, stems, and skins. . . . White wine should 
contain not less than ten per cent nor more than tvjelve per cent by 
weight of absolute alcohol. 

Vinum Album Fortius. — Stronger white wine. (White wine, seven 
parts ; alcohol, one part.) 

These are the only wines recognized by the United States Pharma- 
copoeia. In medical practice a great variety are employed, in accord- 
ance with special indications. It would occupy too much space, and 
be foreign to the purpose of this work, to enter into details in regard 
to particular wines, but some attention should be given to the different 
groups. 

Sparkling Wines. (Champagne, sparkling catawba, etc.) — These 
are wines which have been bottled before the stage of fermentation 
has been completed, hence they are lively, or sparkling, in consequence 
of being charged with carbonic acid. A considerable portion of the 
grape-sugar has not been converted into alcohol ; they are sweet wines, 
therefore, and the quantity of absolute alcohol which they contain is 
relatively low (eight to twelve per cent). Sparkling hock is a lighter 
wine than champagne, and contains less sugar. Sparkling catawba 
more nearly resembles hock than champagne. 

A sophistication now much practiced consists in adding to still 
wines carbonic-acid gas, by pressure, in the same manner that carbonic- 
acid water is manufactured. 

Dry Acid Wines. — The best specimens of this group are the Ger- 
man Rhine and Moselle wines, California hock, and Ohio and Kelly- 
Island catawba. The German varieties are very numerous, and are 
remarkable for their flavor, for the completeness of the fermentation 
(absence of sugar), and for their permanence. The most important 
of the varieties are the following : Diirkheimer, Ungsteiner, Hoch- 
heimer, Deidesheimer, Forster, Rudesheimer, Johannisberger, Lieb- 
frauenmilch, etc. The French wines are, as a rule, rather acid. The 
best known are the clarets, but these are more properly classed with 
the red wines. 

Sweet Wines. — In this group are contained burgundy, still cham- 
pagne, muscatel, malaga, Hungarian tokay, and angelica, madeira, 
etc. The alcoholic strength of these wines, unless fortified, is rela- 
tively low, because the sugar has not been consumed by the fermen- 
tation. 

Light Bed Wines. — The French clarets, the red Rhine wines, the 
American Ives's seedling, and Concord and Hungarian, are members 
of this group. They contain a large proportion of the coloring-matter 
of the grape, and considerable tannic acid. 



532 CEREBRAL SEDATIVES. 

Heavy Red Wines. — Port is the principal representative of this 
group, but it is not a natural wine ; during the process of manufacture 
spirit is added, and its alcoholic strength is raised to thirty or forty 
per cent. California port when fortified, as it probably frequently is, 
should be classed in this division. 

Dry Spirituous Wines. — The most important member of this group 
is sherry. 

Composition and Peopeeties. — The composition of wine is ex- 
tremely complex. The constituents ascertainable by chemical analysis 
do not represent all of the peculiar qualities which render various 
wines desirable. Bouquet and flavor can not be determined by the 
most expert chemist, and elude all other means of investigation but 
the tongue and nose of the " wine-taster." 

A wine is a solution of alcohol in water, mixed with various con- 
stituents of the grape. The proportion of alcohol ranges from six to 
forty per cent — the largest quantity being found in the artificial wines, 
such as port and sherry. The proportion of sugar varies greatly — 
from three to twenty-five per cent. The acids are fixed (tartaric) and 
volatile (acetic). The relation between these several constituents is 
nearly as follows : Port contains about fifty-three parts by weight of 
alcohol to one part of acid, and twelve parts of sugar to one part of 
acid. The average of sherry is thirty-nine of alcohol and 1*5 of sugar 
to' one of acid. In the sweet wines, the average is about thirty parts 
of sugar to one part of acid and fifteen parts of alcohol. In the acid 
wines, the average proportion of alcohol to acid is as eighteen to one, 
while the sugar is almost absent, and in some of the best is entirely so. 
Those are dry wines which are free from sugar. Besides tartaric and 
acetic acids, wines contain, in much smaller quantity, malic, tannic, 
and carbonic acids. Wines containing less than three hundred grains 
of acid to the gallon are wanting in flavor ; on the other hand, an ex- 
cess of acid over five hundred grains to the gallon is too sour to be 
agreeable. The coloring-matter of wine varies greatly, and the dis- 
tinction between "white" and "red" depends on the quantity present 
in these different varieties. The red wines are more astringent, due to 
the larger proportion of tannin which they contain, and they are also 
rougher to the taste. 

Wine contains a great many mineral constituents; tartrates of potas- 
sa and lime, chlorides of sodium, potassium, and calcium, and sulphates 
of potassa and lime. The percentage of ash ranges from 0*18 to 0'40. 

Note. — The wine-consumers of the United States have been so long habituated to the 
wines of foreign source, that they have been unable to overcome the prejudices against 
the wines of native production. The vineyards of California, of the interior lakes, and of 
various parts of the Middle States now produce wines so thoroughly good, that a revision of 
the present standards of taste is demanded alike in the interests of consumers and producers. 
A sound taste and patriotism coincide in claiming the highest excellence for our native wine. 



WINE. 533 

The peculiar odor of wine (bouquet) is due to cenanthic acid, and 
cenanthic ether, produced by a reaction of the acid on the alcohol. 

According to Fresenius, the quality of a wine is so much the better 
the less it contains of free acid, the more it contains of sugar, and 
the greater its quantity of extract ; and, further, its quality is not de- 
cidedly influenced by the quantity of alcohol, and can not be deter- 
mined by its specific gravity. 

A certain quantity of free acid is necessary, but it should not be 
greater than can be masked by the alcohol, sugar, and extractive mat- 
ter. The flavor and odor of wine are produced by ethers formed by 
the action of the free acid on the alcohol ; hence the importance of 
this acid constituent. 

Dr. Druitt, in his " Report on Cheap Wines," has very well summed 
up the qualities of good wine in the following conclusions : 

" 1. The wine should have an absolute unity, or taste as one whole. 

"2. Wine should contain a certain amount of alcohol. 

" 3. Wine should be slightly sour. 

"4. Sweetness is characteristic of a certain class of wines, while 
certain other wines are dry, or free from sugar. 

"5. Wines should have a taste free from mawkishness, and indica- 
tive of instability. 

" 6. Roughness or astringency is a most important property, and 
belongs to most red wines. In moderation it is relished, as sourness 
is, by a healthy, manly palate, just as the cold souse is welcome to the 
skin. In excess it leaves a permanent harshness on the tongue. 

" 7. The wine must have body. This is the impression produced 
by the totality of the soluble constituents of wine — the extractive, that 
which gives taste to the tongue, and which, as wine grows older, is 
deposited along with the cream of tartar forming the crust. 

" 8. Bouquet is that quality of wine which salutes the nose. Fla- 
vor is that part of the aromatic constituent which gratifies the throat. 

" 9. The wine must satisfy. A man must feel that he has taken 
something which consoles and sustains. Some liquids, as cider and 
thin wines, leave rather a craving, empty, hungry feeling after them." 

Physiological Actions. — As respects the alcohol which they con- 
tain, the physiological actions of wines could be discussed with the 
previous article. But wines differ from alcohol, and from brandy and 
whisky, not only in spirituous strength, but in the possession of the 
varied and important constituents mentioned above. 

The sparkling wines are more sedative to the stomach, and are 
more intoxicating, relatively to their alcoholic strength, than the other 
wines.' As they contain a considerable quantity of unappropriated 
sugar, acid fermentation is apt to occur, and acidity, with headache, 
follows their use. As respects the influence on the pulse, they are less 
stimulating than the stronger wines, and the experiments of Dr. Ed- 



534 CEREBRAL SEDATIVES. 

ward Smith have demonstrated that they increase the excretion of car- 
bonic acid. 

The dry acid wines are more purely stimulant, partly in conse- 
quence of their alcohol, and partly in consequence of the important 
ethers which they contain. As they are free from sugar, acid fermen- 
tation does not follow their use, but with some subjects the free acid 
present in them disagrees. 

The sweet wines have, generally, considerable body and alcoholic 
strength. They rather pall on the appetite ; are apt to disorder the 
stomach, and produce headache. Some of them have fine bouquet 
and flavor, and are satisfying to the palate ; but as a rule they are not 
borne as well as the dry wines. 

The red wines, light and dark, are astringent and have considerable 
body and alcoholic strength. The tannin which they contain, and 
coloring-matters, are apt to cause stomach-disorders, constipation, and 
a febrile state. By reason of the large amount of alcohol in them, 
especially in port, they approach whisky and brandy in power as 
stimulants and narcotics. 

Therapy. — 

" Good wine is a good familiar creature, if it be well used." (Othello.) 

The effervescing or sparkling wines often render important service 
in irritable states of the stomach without inflammatory action. The 
vomiting of pregnancy, of seasickness, of yellow fever, of cholera- 
morbus, with depression, and of true cholera, are not infrequently ar- 
rested by tablespoonful-doses of iced champagne every fifteen minutes. 

A generous glass of a dry wine (sherry) taken with the principal 
meal greatly assists the digestion of the sedentary who suffer from 
atonic dyspep>sia. The wine should be taken during the course of the 
meal, and at no other time. Persons who suffer from acidity, due to 
an excess of formation of acid gastric juice, are relieved by a dry acid 
wine, taken during the meal or just previously. For this purpose a 
genuine Rhine wine — for example, Forster Riesling — is best. 

In diarrhoea and dysentery, after the acuter symptoms have sub- 
sided, and when there is considerable depression, those wines are in- 
dicated which contain tannin — the red wines, claret, Ives's seedling, 
port, etc. 

In cases of ancemia and chlorosis, wines render an important ser- 
vice by increasing digestion and assimilation. To aid in this process, 
red wines with a good deal of sugar and extractives are most neces- 
sary. When wines produce headache, and the digestion is disordered 
by them, and the appetite impaired, they are not serviceable in these 
maladies. Moreover, for the nervous and hypochondriacal, wines must 
be prescribed with caution, for the habit of indulgence is quickly ac- 
quired by such subjects. In convalescence from acute diseases, there 



WINE. 535 

can be no difference of opinion as to the great value of wine as a 
restorative. Wines of considerable body and alcoholic strength are 
indicated under these circumstances. When there is much nervous 
restlessness, wakefulness, and cardiac depression, a wine rich in ethers 
is specially useful, according to Anstie. In chronic wasting diseases, 
as phthisis, scrofula, etc., the stronger wines, as sherry, burgundy, 
port, may take the place, in some cases, of the spirits, whisky and 
brandy. In these wasting diseases, wines serve a double purpose : 
they stimulate the activity of the primary assimilation, and within 
certain limits they are utilized as foods. They are only harmful when 
digestion is impaired by them ; and under no circumstances can they 
take the place of other aliment. 

In passive haemorrhages, in the hemorrhagic diathesis and in pur- 
pura, wines are indicated, because they elevate the arterial tension, 
and thus act indirectly as haemostatics. 

In various acute diseases, when the action of the heart becomes 
feeble and irregular, the pulse dicrotic, and there occur wakefulness 
and delirium, a wine of considerable alcoholic strength and rich in 
ethers is peculiarly serviceable. Wines are much more largely used 
in fevers {typhoid, typhus, etc.) than in any other forms of disease, 
and the circumstances requiring their employment are indicated in the 
preceding sentence. The routine practice of alcoholic stimulation in 
fevers can not be justified. Exact indications for the use of wine 
exist in the state of the heart and arterial system, and of the brain, 
and these should be sought for in every case, instead of prescribing 
for the name. In fevers, wines precede the spirituous liquors. The 
first weakening of the heart's action, the beginning of dicrotism, and 
the transitory delirium and subsultus, require champagne and the light 
and acid wines ; more profound adynamia, with diarrhoea, the stronger 
red wines. 

In acute inflammations (pneumonia, pleuritis, peritonitis, etc.), 
wines serve to maintain the strength when the powers of life are 
weakening, or to maintain the functions of brain and heart when 
crises occur, as in pneumonia. The rules for the administration of 
wine in acute inflammations are the same as in fevers. 

Next to their use in fevers, wines are most frequently prescribed, 
and with the greatest advantage, in surgical practice, for the conse- 
quences of wounds and injuries, to support the powers of life under 
protracted and profuse suppuration, and to favor digestion and as- 
similation in the course of convalescence from surgical diseases. 

The immediate stimulant effect of wine is of great value in sudden 
and profuse loss of blood, whether from injuries and surgical opera- 
tions, or post partum. A highly-etherized wine of good body is most 
useful here, because it produces a prompt effect and easily yields up 
the force needed to keep the heart and brain in action, and, in the 



536 CEREBRAL SEDATIVES. 

case of the relaxed uterus, to furnish the power needed to procure its 
energetic contraction. 

Beer, Ale, Porter. — Beer and ale are fermented liquors made from 
malted grain, hops and other bitter substances being added. Ale is 
produced by rapid fermentation, in which the yeast rises to the sur- 
face, and beer is the product of slow fermentation in cool cellars, the 
yeast falling to the bottom. Hence the name lager-beer. Porter em- 
braces the qualities of beer and ale, and is so named on account of its 
strong quality, which endeared it to porters. 

Composition. — The proportion of alcohol varies somewhat. In 
Edinburgh ale it amounts to about six per cent ; in brown stout, to 
six per cent ; in porter, to four per cent ; in beer, two to three per 
cent. Besides alcohol and water, these malt liquors contain extract 
of malt, five to fourteen per cent ; carbonic acid, 0*16 to 0*60 per cent. 
In the extract are found also various aromatic substances, lactic acid, 
potash and soda salts, etc. 

Physiological Actions. — So far as the alcohol is concerned, beer, 
ale, and porter correspond in physiological actions to the spirituous 
liquors and to wines. As they contain malt extract, their nutritive 
value is greater than spirits and wine. An important constituent, the 
hop, being an aromatic bitter, the tonic and stomachic qualities of 
these malt liquors are also greater than their congeners. The process 
of fermentation, however, lessens in a remarkable degree the nutritive 
and stomachic qualities of the constituents which enter into the com- 
position of malt liquors. Their value as foods is much exaggerated 
by the habitual consumers. They increase the appetite and favor the 
deposition of fat. Although the malt beverages do not cause to any- 
thing like the same extent the alterations in the nervous centers pro- 
duced by the spirituous, they induce other and almost as important 
structural changes. They set up in the organism fatty degeneration 
of various tissues, notably of the liver and heart. The habitual beer- 
consumer is known by his obesity, his flushed face, embarrassed breath- 
ing, puffy hands, yellow conjunctiva, etc. ; he is usually short-lived, and 
the end is reached by hepatic and cardiac disorders. It is certainly 
true that a moderate amount of beer may be taken daily, for a life- 
time, without any obvious impairment of the functions ; but excessive 
use produces with great certainty the unfavorable effects above de- 
scribed. 

Therapy. — Beer, ale, and porter are not usually prescribed in acute 
maladies. They are, however, much and justly esteemed as stomachic 
tonics and restoratives in chronic wasting diseases — for example, in 
convalescence from acute diseases and surgical injuries, in cases of 
profuse and protracted suppuration, prolonged lactation, diseases of 
the joints, scrofula, phthisis, etc. Strumpf finds, however, that alco- 



PARALDEHYDE. 537 

"holic beverages only increase the amount of fat in milk, and not the 
quantity of milk as a whole. 

The malt liquors are harmful in all stomach-disorders with acidity, 
and in chronic affections of the liver, especially fatty liver. When 
these beverages do not improve the appetite, when they cause a sense 
of epigastric oppression, and when they coat the tongue, they are not 
beneficial. 

When wakefulness is due to cerebral anaemia, a glass of beer or 
ale at bedtime will frequently produce satisfactory sleep. Puerperal 
mania, delirium tremens, and acute maniacal delirium, when these 
symptoms coexist with a condition of adynamia, are greatly benefited 
by the liberal use of ale (pale or Edinburgh ale). The effect of this 
remedy is to arouse the appetite, to quiet delirium, and to produce 
sleep. In melancholia, excellent results are often obtained by the use 
of porter with a little tincture of opium. 

Extract of Malt. — Under this name is known a thick, sirupy 
liquid having a golden or yellowish-brown color, a sweetish taste, and 
the odor of malt. If properly prepared, it contains, besides the con- 
stituents of barley, the ferment diastase. It is much prescribed for 
its restorative qualities, and as a vehicle for cod-liver oil. It is best 
administered immediately after meals. 

Paraldehyde. — Under this name is described a polymeric modifica- 
tion of aldehyde. Above the temperature of 51° Fahr. it is a color- 
less liquid, having a peculiar ethereal odor, and a specific gravity of 
•998. It boils at about 225° Fahr. It is soluble in eight parts of 
water at 52° Fahr. The dose ranges from 3 ss to 3 ijss. Water is 
a suitable menstruum. 

In appropriate cases it has proved to be an admirable hypnotic, 
with many of the qualities but none of the dangers of chloral. In its 
action, first the cells of the cerebrum are affected, and sopor is induced. 
Unlike the other agents of this class, its soporific action is not pre- 
ceded by excitement (Cervello). Next to the cerebral hemispheres 
the effects of paraldehyde are expended on the medulla oblongata, 
and then on the spinal cord. A lethal dose stops the functioning of 
the medulla and the respiratory center, but the cardiac functions cease 
after the respiratory. It differs from chloral in the important respect 
that it has no paralyzing action on the heart. The effect of paralde- 
hyde is, however, not so persistent as that of chloral, but frequent 
administration of the one can safely compensate for the greater power 
of the other (Albertoni). 

Paraldehyde may be prescribed as a hypnotic in the conditions 
usually requiring such a remedy — in fevers, rheumatism, gout, prurigo, 
etc. (Morselli). It is, however, in mental and nervous disorders that 
it is likely to be most employed. By the Italian physicians, to whom 



538 CEREBRAL SEDATIVES. 

we owe its introduction, it has been very successfully used in acute 
mania, in the wakefulness of dementia paralytica, in hysterical seiz- 
ures, and in ordinary insomnia. To succeed, it must be given in 
sufficient quantity. The maximum dose mentioned above ( 3 ijss) has 
often been given without any ill effect or any after-trouble of any 
kind, and has often proved to be necessary. 

Paraldehyde has gained in favor since its introduction, and the 
range of its application has constantly widened. It has been used 
with success in the treatment of delirium tremens, in strychnine-poi- 
soning, in the milder cases of neuralgia, and as an expectorant ; but 
in the more dangerous affections the dose must be large enough to 
make an impression — from 3 ss to 3 ij. These large doses are the safer, 
in that paraldehyde has no depressing action on the heart and lungs 
(Coudray). An increasing use as an expectorant, and as an ingredient 
of cough-mixtures, confirms what has been stated of its beneficial 
effects in the treatment of cough, and bronchial affections in general. 

Although paraldehyde has an agreeable, fruity odor, the taste is 
rather pungent, and hence it were better given in the form of the pre- 
scriptions below : 

3 Paraldehyde, 3 j ; spirit, chloroform., v\ xv ; pulv. tragacanth. 
com., 3 j ; syrp. aurant. cort., § ss ; aquae ad % iij. M. Sig. : One or 
two doses (Hodgson). 

^ Paraldehyde 3 ij ; ol. amygd. ex., 3 ij ; chloroformi, ttj, x ; ol. 
cinnamomi, m, ij. 

Authorities referred to : 

Coudray, Dr. These de Paris, 1885, quoted by Annuaire de Therapeutique, 1885. 

Desnos, Dr. Bui. Gen. de Therap. for 1886. 

Dujardin-Beaumetz, Dr. Ibid. 

Kerayal et Nerkam. Annuaire de Therap. for 1886. 

Preyost, Dr. J. L. Bui. Gen. de Therap. Ibid. 

Methylal. — This new agent has been long known to chemists, but 
its utilization as a remedy is very recent. Methylal is highly volatile, 
is soluble in water and alcohol, and can be made into a homogeneous 
unguent with oils and fats. It is a very diffusible substance, acts very 
quickly, and is eliminated rapidly. When it enters the stomach a sen- 
sation of warmth is produced which diffuses throughout the system, 
the vascular tension falls, the heart beats rapidly, respiration is in- 
creased, and the temperature is said to be lowered ; but we are inclined 
to think that an error of observation has been committed here. Sleep is 
soon induced, but the extent and duration of this stage of the action are 
much influenced by the quantity given and by the rate of elimination, 
which is rapid or slow, according to the state of the eliminating organs. 

Methylal lessens the reflexes, and is antagonistic to strychnine and 
the tetanizers in general. 



CHLORIDE OF METHYL.— URETHAN. 539 

The dose of methylal ranges from five to fifteen grains. As it is 
soluble in water it may be given subcutaneously as by the stomach. 
The maladies in which it has been used with encouraging results are 
wakefulness, convulsive diseases, as epilepsy, in neuroses of the re- 
spiratory organs, and in cases of neuralgia of superficial nerves. It 
is applied externally, mixed with almond-oil or alcohol, in the propor- 
tion of ten to twenty per cent of the medicament. The rate of 
dosage must be comparatively rapid, as the diffusion and elimination 
of the remedy go on so quickly. In making external applications, the 
state of the skin and its idiosyncrasies must be heeded. Violent in- 
flammation may be caused by too free and too frequent application of 
the remedy. 

Chloride of Methyl. — In 1884 Debove published a paper on the 
anaesthetic and analgesic properties of methyl chloride. But little 
attention was given to the subject. Very recently he has reported a 
fresh series of cases, and the actions of the new anaesthetic have been 
examined into with more zeal. He reports the treatment of one hun- 
dred and fifty cases of sciatica, of which only one in twenty failed of 
relief. He again asserts that lumbago and nerve-pain are cured imme- 
diately, and if relapses occur, they are quickly ended by renewed use 
of the remedy. Of the cases of facial neuralgia, eighteen in number, 
sixteen were cured. 

Debove gives precise instructions about the mode of applying the 
remedy. As a volatile, ether-like material, rapid evaporation takes 
place when it is applied by the spray-douche over the affected area. 
An ordinary atomizer suffices. The spray should be applied over as 
many nerve-filaments as possible, but it is necessary to avoid produc- 
ing an inflammation of the skin or an erythema. Persons having an 
irritable skin or a tendency to disease of the skin must be treated with 
caution and with the minimum of effect at the outset. Debove ad- 
vises discretion in the case of those affected with albuminuria and dia- 
betes. 

The special advantage possessed by methyl chloride is the external 
application, which never involves more serious results than some tem- 
porary irritation of the skin ; and, if the reports of its success be de- 
pendable, we have in this method the power to cure in a more ready, 
easy, and effective manner than ever before. 

Authorities referred to : 

Deboye, Dr. Societe medicale des Hopitaux, in Revue de Therap., 1887. 
Elay, Dr. On Methylal, London Medical Record, May 16, 1887. 

Urethan. — A combination of carbonic acid and ethylic ether. 
From a priori considerations, the distinguished pharmacologist of 
Strasburg, Professor Schmiedeberg, was led to the conclusion that 



540 CEREBRAL SEDATIVES. 

these compounds of ethyl must have the hypnotic powers, to some 
extent, of the group. A careful investigation confirmed this view. 
Of these ethyl compounds, called urethans, he found that the carba- 
mate of ethyl was the most satisfactory, and to this he gave the ge- 
neric name of the group, urethan. He submitted this to a charac- 
teristically thorough examination, and was thus able to confirm his 
original conception of the physiological actions. 

Properties. — Urethan occurs in whitish crystals, is without odor, 
is tasteless, and insoluble in water. The dose is very unequal, for so 
much depends on the purpose in view, the age, character, and suscepti- 
bility of the patient. The dose may be stated as from five grains to 
a drachm or more. The best form in which to administer it is the 
compressed pellet, but the capsule, the wafer, or simple powder may 
be employed. It has been ascertained of late, that the best hypnotic 
action can be developed only by massive doses. Saundby, however, 
narrates two cases of insomnia in which two grains at a dose seems to 
have been sufficient for the purpose ; but the general opinion is that 
from forty to eighty grains must be given to bring about a decided 
hypnotic action. 

Urethan has no irritating effect on the stomach, and does not im- 
pair digestion. Although insoluble in water, the stomach juice dis- 
solves it readily, and hence it promptly diffuses into the blood. Two 
results, apparently opposite in character, are produced in due order : 
the first impression is of a stimulant character, but very brief in dura- 
tion ; the next consists in diminution of action, slowing of circulation 
and respiration, decline of temperature, and weakening of the reflexes, 
which gradually lessen in promptness and finally disappear. TTith the 
onset of the depression stage, drowsiness comes on, tranquil sleep suc- 
ceeds, and this physiological condition passes into coma and insensibil- 
ity if the quantity administered be toxic. Urethan is not actively 
toxic, however, for Prof. Anrep maintains that so large a quantity as 
eight to twelve grammes ( 3 ij — 3 iij) can be taken by an adult, with- 
out causing danger-symptoms. By Jaksch, one gramme (15J grs.) is 
held to be sufficient to cause sleep. Mairet and Combemale adminis- 
tered it in various forms of mental diseases, and thus ascertained how 
far its hypnotic power is influenced by the character of the case, the 
presence of pain, and other disturbing influences. Urethan is not an 
analgesic, and hence pain will prevent its hypnotic action. The ex- 
citement of mania, noises, and odd situations, may also prevent the 
hypnotic action. The most frequent cause of dissatisfaction is insuf- 
ficient quantity, for then the desired action fails, and consequently the 
remedy is discredited. 

Unpleasant after-effects do not occur unless stomachal troubles 
interfere, and headache, nausea, and vertigo are quite exceptional. 
When the conditions are favorable, sleep comes on in fifteen minutes 



URETHAN. 541 

to an hour, is quiet, and lasts from six to eight hours. When it is 
administered for many days in succession its power lessens, although 
the dose may be increased ; but if stopped for a time, the susceptibil- 
ity of the brain is restored, and then urethan can be resumed again. 

Therapy. — The therapeutical applications of urethan are based 
on its physiological properties. Schmiedeberg began the consideration 
of its actions for a priori reasons, and, these being confirmed, he ex- 
tended his investigations to the physiological and therapeutical aspects 
of the subject. Its hypnotic powers, its influence over the reflexes, 
and its antipyretic action, were accurately mapped out by the great 
pharmacologist, so that now the value of the new agent is known, its 
limitations are defined, and the morbid states to which it is applicable 
clearly shown. 

In general terms, urethan is a hypnotic which may be successfully 
used to procure quiet and sleep, when the conditions are favorable to 
its action. As a hypnotic, its position is similar, but not quite equal, 
to that of paraldehyde. 

Urethan is antagonistic to strychnine, but only the largest doses, 
under the most favorable circumstances, will make it powerful enough. 
Being a moderator of reflex action, it may prove useful in epilepsy, 
chorea, spasm, and cramp. It is probable, also, that it may be bene- 
ficial in the spasmodic respiratory neuroses. By way of illustration, 
the experiences of Dr. Ferreira may be referred to here. Cases of 
epilepsy, of urcemic convulsions, of tetanus, and of delirium tremens, 
were all influenced favorably, but a distinctly curative effect was 
manifest in some of the epileptic subjects, and in the cases of de- 
lirium tremens. Urethan should have further trial in the treatment 
of epilepsy, especially in those nocturnal in occurrence. 

Sulfonal occurs in odorless, colorless, and tasteless crystals, soluble 
in 100 to 150 parts of cold water, but in boiling water 1 to 18 to 20 
parts. It is a very stable compound chemically, and is not acted on 
by alkalies, acids, or oxidizing agents in general. Kast, who first ex- 
amined sulfonal by the physiological method, ascertained that it acts 
without causing any disturbance of function, and that no unpleasant 
after-effects occur. In doses of 30 to 60 grains it causes sleep that is 
physiological in character, but it has no analgesic effect, and severe 
pain rather hinders the hypnotic action. It has a position between 
chloral and paraldehyde — more efficient than paraldehyde, and less 
toxic than chloral — and is a useful hypnotic for the various conditions 
requiring such a remedy. 

Hypnone is one of the new remedies of the narcotic kind, studied 
first by Popof and Nencki, and subsequently clinically by Dujardin- 
Beaumetz and pupils. The chemical name is phenyl-methyl- acetone, 
and " Hypnone " is an artificial name given for convenience. The dose 
is one to three grains. 



542 CEREBRAL SEDATIVES. 

Hypnone is a hypnotic, and has less pain-relieving power. It is 
adapted to the same conditions as those in which paraldehyde is now 
prescribed. Dubois advises the use of hypnone to promote anaesthe- 
sia when chloroform is administered. But its chief employment will 
be confined to the more simple cases of insomnia, we conclude after 
some investigation of its powers. 

iEther— Ether. JtJther, Fr. ; Aether, Ger. 

A liquid composed of about seventy-four per cent of ethyl oxide, 
and about twenty-six per cent of alcohol containing a little water. 
Specific gravity about 0*750 at 60° Fahr. 

JEtlier Fortior. — Stronger ether. A liquid composed of about 
ninety-four per cent of ethyl oxide, and about six per cent of alcohol 
containing a little water. Specific gravity not higher than 0*725 at 
60° Fahr. 

A thin, very diffusive, clear, and colorless liquid, of a refreshing, 
characteristic odor, a burning and sweetish taste, with a slightly bit- 
ter after-taste, and a neutral reaction. It is soluble in all proportions 
in alcohol, chloroform, benzol, benzin, fixed and volatile oils, and dis- 
solves in eight times its volume of water at 60° Fahr. It boils at 98*6° 
Fahr. Ether is highly inflammable, and its vapor, when mixed with 
air and ignited, explodes violently. 

Spiritus ^Etheris. — Spirit of ether. Consists of ether, thirty parts ; 
alcohol, seventy parts. Dose, tt|, x — 3 j. 

Spiritus ^Etlieris Compositus. — Compound spirit of ether. Hoff- 
man's anodyne. (Ether, alcohol, and ethereal oil.) A colorless, vola- 
tile, inflammable liquid, having an aromatic, ethereal odor, and a 
burning, slightly sweetish taste. Its specific gravity is 0*815. It is 
neutral, or but slightly acid to litmus. It gives only a slight cloudi- 
ness with chloride of barium ; but when a fluid ounce of it is evapo- 
rated to dryness with an excess of this test, it yields a precipitate of 
sulphate of barium, which, when washed and dried, weighs six and a 
quarter grains. When a few drops are burned on glass or porcelain, 
there is no visible residue, but the surface will have an acid taste and 
reaction. A pint of water, by the admixture of forty drops, is ren- 
dered slightly opalescent. Dose, tti x — 3 j. (Pharm. 70.) 

Spiritus JEtheris Nitrosi. — Spirit of nitrous ether. Sweet spirit 
of nitre. An alcoholic solution of ethyl nitrite, containing five per 
cent of the crude ether. (U. S. P.) Is a volatile, inflammable liquid 
of a pale-yellow color, inclining slightly to green, having a fragrant, 
ethereal odor, free from pungency, and a sharp, burning taste. It 
slightly reddens litmus, but does not cause effervescence when a crys- 
tal of bicarbonate of potassium is dropped into it. When mixed with 
half its volume of official solution of potassa previously diluted with 
an equal measure of distilled water, it assumes a yellow color, which 






ETHER. 543 

slightly deepens, without becoming brown, in twelve hours. A portion 
of the spirit in a test-tube half filled with it, plunged into water heated 
to 145°, and held there until it has acquired that temperature, will boil 
distinctly on the addition of a few small pieces of glass. 

Spirit of nitrous ether has a specific gravity of 0*837, and contains 
five per cent of its peculiar ether. It should not be long kept, as it 
becomes strongly acid by age. Dose, 3 ss — f ss. 

JEther Aceticus. — Acetic ether. Acetate of ethyl. A transparent 
and colorless liquid, of a strong, fragrant, ethereal, and somewhat ace- 
tous odor, a refreshing taste, and neutral reaction. Soluble in all pro- 
portions in alcohol, ether, and chloroform, and in about seventeen parts 
of water. Specific gravity, 0*889 to 0*897. It is inflammable. Dose, 
m x— 3 j. 

Ethyl Bromide. — Hydrobromic ether. Is a colorless liquid, vol- 
atile, having a fragrant odor, and a hot, somewhat sweetish taste, 
afterward rather bitter. It is not inflammable. Its specific gravity is 
1*420, and it boils at 104° Fahr. ; readily decomposes on exposure to 
light and air, bromine being separated. It is freely soluble in alcohol 
and ether, but very sparingly in water. Dose, for internal and sub- 
cutaneous administration, Tq, x — 3 j. 

Antagonists and Incompatibles. — Ether dissolves iodine, bro- 
mine, corrosive sublimate, the volatile and fixed oils, many resins and 
balsams, tannin, caoutchouc, most of the alkaloids, sulphur, and phos- 
phorus — the last-named two sparingly. As respects its stimulant and 
anodyne properties, it is antagonized by arterial sedatives, quinine, 
oxygen, protoxide of nitrogen, the tetanizing alkaloids, strychnine, 
picrotoxin, etc. 

Synergists. — Alcohol and its congeners, chloroform, arterial stimu- 
lants, cerebral stimulants, etc., assist the action of ether. 

Physiological Actions. — The physiological effects of ether when 
inhaled require separate treatment ; hence the subject of anaesthesia 
by vapors will be discussed in a special article. It is now proposed 
to treat of the effects of ether administered by the usual route — the 
stomach. 

Ether has a taste at first sweetish, but afterward hot and pungent. 
It leaves a cooling sensation in the stomach after the subsidence of 
the burning, and this quickly diffuses over the body. Increased action 
of the heart, flushing of the face, warmth of the surface, with increased 
diaphoresis, follow in a few minutes. The senses are quickly excited, 
the mind becomes more active, ideas flow rapidly, and the cerebral 
phenomena of alcoholic intoxication ensue. These effects are of short 
duration, and a feeling of content, mental calm, and sopor, succeeds 
to the transient excitement. Ether is eliminated rapidly, chiefly by 
the lungs, and the whole duration of the effects of even a large quan- 
tity ( 3 ij) does not exceed an hour. 



5-44 CEREBRAL SEDATIVES. 

Therapy. — Before it is administered, ether should be diluted with 
alcohol, which renders it readily miscible with water. 

A few drops of Hoffman's anodyne (ttt, x — n\, xx) in some camphor- 
water is an excellent remedy to expel flatus from the stomach. Gas- 
tralgia may often be quickly relieved by the same means. A few 
drops of ether, added to cod-liver oil, enable the stomach to bear it 
more easily, and, it is said, favors its digestion ; that it accomplishes 
this object by increasing the pancreatic juice, is the observation of 
Claude Bernard. Paroxysms of hepatic colic are sometimes treated by 
the internal administration of ether, but this treatment is by no means 
equal in effectiveness to the inhalation of the vapor. Ether mixed 
with turpentine has the power to dissolve hepatic calculi, hence the 
remedy of Durande. As Trousseau well remarks, chemical results 
which take place in the laboratory are not reproduced in the body 
with equal facility. The rapidity with which ether diffuses into the 
blood at the temperature of the stomach would appear to preclude the 
possibility of its exerting any solvent action on a calculus fixed in an 
hepatic duct. Whatever good result- is secured by the administration 
of the remedy of Durande must be ascribed to the anodyne and anti- 
spasmodic action of its constituents. 

Sudden failure of the heart 9 s action (syncope), from mental emo- 
tion or hysteria, is most promptly remedied by the administration of 
Hoffman's anodyne. Mild attacks of angina pectoris, and of sp>as- 
modic asthma, may sometimes be aborted by a full dose of the ethe- 
real preparations. The subcutaneous injection of ether is very effec- 
tive in sudden cardiac depression. 

Nervous or hysterical sick-headache is quickly cured by 3 ss doses 
of spirit of ether. The most important application of these ethereal 
remedies is in the treatment of the hysterical paroxysms. As the ac- 
tion is prompt and quickly expended, it is obvious that ether or Hoff- 
man's drops are only adapted to sudden hysterical seizures, and not to 
more lasting nervous symptoms arising in an hysterical constitution. 
Nothing can be more satisfactory than the prompt relief by these 
agents of hysterical flatulence, globus hystericus, and hystero-epilepsy. 
I£ Spts. etheris composit., tinct. valerian, ammon., aa 3 j. M. Sig. : 
A teaspoonfid in loater every fifteen minutes until relieved. 

As a cardiac stimulant in fevers, the ethereal preparations are oc- 
casionally prescribed. For a quick effect, in an emergency of practice, 
they are useful, but are not equal to spirits and wine when a sustained 
effect is required. 

Nitrous ether is employed in domestic practice as a mild diapho- 
retic, a diuretic, and carminative. It no longer occupies the place it 
formerly held in medical practice, but it is occasionally prescribed in 
feverishness, as a constituent in expectorant mixtures, in combination 
with diuretic medicines, etc. 



ETHER. 545 

Ether by the Hypodermatic Method. — Within the past few- 
years, the subcutaneous injection of ether has taken an important posi- 
tion in therapeutics. It is necessary, therefore, to enter into this sub- 
ject fully. 

When ether is injected beneath the skin, more or less burniig pain 
is felt at the point of insertion, and a puffy swelling is produced. In 
most subjects this swelling subsides in an hour or two, and no trace is 
left of the operation. In some instances, an induration, the size of a 
filbert, forms, and slowly disappears. Very rarely inflammation is set 
up about the site of the injection, and followed by suppuration, with 
more or less sloughing. If not too large an amount, suddenly and vio- 
lently injected, is used, there will be no untoward results. 

The effects of ether subcutaneously are the same in kind as, but 
more powerful in degree than, those produced by the stomachal admin- 
istration. A local anaesthetic impression is made ; in a few seconds, 
the action of the heart is powerfully increased, and soon the usual cere- 
bral effects are manifest. 

Ether was first employed subcutaneously by Dr. Comegys, of Cin- 
cinnati, in the treatment of sciatica. He injected from fifteen minims 
to a half -drachm, in the neighborhood of the affected nerve. This 
practice has been followed by others with success, and is now more or 
less widely used as a substitute for "the deep injection of chloroform." 
It is very desirable to have some exact observations which will deter- 
mine the comparative value of these expedients. 

The most important applications of ether, hypodermatically, are as 
a cardiac stimulant in the case of sudden and extreme depression of 
the heart, and as a general stimulant in adynamic states. In the de- 
pression caused by haemorrhage, whether pulmonary or post partum, 
the injection of ether may obviate the necessity for transfusion. This 
practice is strongly urged by Peter, Fereol, and Mile. Ocoumkoff, who 
report cases in confirmation. Remarkable results have been effected 
by the subcutaneous injection of ether in adynamic pneumonia (ty- 
phoid pneumonia), as practiced by M. Barth. Thus, of fourteen cases 
of severe type treated by these injections, eleven were cured. The 
quantity injected was about fifteen to twenty minims two, three, or 
four times a day, according to the degree of adynamia. The effects 
which follow almost immediately are these : the respiration becomes 
more easy, the pulse takes on more strength and volume, the tongue 
moistens, and the countenance assumes a better appearance. In from 
two to three minutes after the injection has been practiced, the odor 
of ether is recognizable in the breath (Barth). 

In the eruptive fevers, especially in variola, the injections of ether 

have been used with admirable results (Castel). It is in a high degree 

probable that the same treatment will prove very useful in low forms 

of septic and inflammatory diseases in general. There can scarcely 

36 



546 CEREBRAL SEDATIVES. 

be any doubt that we have in this method a most useful addition to 
our therapeutical resources. 

In place of ether, hydrobromic ether has been utilized in the treat- 
ment by the subcutaneous method of various spasmodic diseases, as 
whooping-cough, chorea, asthma, and similar affections. 

Chloroformum.— Chloroform. Chloroforme, Fr. ; Chloroform, Ger. 

Chloroformum Yenale. — Commercial chloroform. A liquid con- 
taining at least 98 per cent of chloroform. It has nearly the same 
sensible properties as purified chloroform. Its specific gravity should 
not be lower than 1*470. 

Chloroformum Purificatum. — Purified chloroform. A heavy, clear, 
colorless, diffusive liquid, of a characteristic pleasant ethereal odor, a 
burning sweet taste, and a neutral reaction. Soluble in about two hun- 
dred parts of water, and in all proportions in alcohol or ether ; also in 
benzol, benzin, fixed or volatile oils. Sp. gr. l'485-r490 at 60° Fahr. 

If five cubic centimetres of purified chloroform be thoroughly agi- 
tated with ten cubic centimetres of distilled water, the latter, when 
separated, should not affect blue litmus-paper (absence of acids), nor 
test-solution of nitrate of silver (chloride), nor test-solution of iodide 
of potassium (free chlorine). If a portion be digested warm with solu- 
tion of potassa, the latter should not become dark-colored (absence of 
aldehyde). If a few cubic centimetres be permitted to evaporate from 
blotting-paper, no foreign odor should be perceptible after the odor of 
chloroform ceases to be recognized. (IT. S. P.) 

When shaken with an equal volume of sulphuric acid, in a bottle 
closed by a glass stopper, and allowed to remain in contact twenty- 
four hours, no color is imparted to either. When one fluid drachm is 
evaporated spontaneously with one drop of a neutral, aqueous solution 
of litmus, the color of the latter is not reddened. The result of the 
test is the same if the chloroform contained in a white glass bottle has 
been previously exposed to direct sunlight for ten hours. 

Mistura Chloroformi. — Chloroform mixture. Purified chloroform, 
eight parts ; camphor, two parts ; fresh yolk of egg, ten parts ; water, 
eighty parts. M. Dose, a tea to a tablespoonful. 

Sjriritas Chloroformi. — Spirit or chloroform. Purified chloroform, 
ten parts ; alcohol, ninety parts. Dose, 3 ss — 3 j. 

Antagonists and Incompatibles. — Chloroform separates from the 
mixture when prescribed with weak spirits or glycerin. It is soluble 
in alcohol (ten to six), in ether (one to seven), in w T ater (one to two 
hundred). It dissolves very freely in olive-oil and turpentine, but does 
not dissolve in or mix with glycerin. It has very extensive solvent 
power, dissolving caoutchouc, gutta-percha, mastic, tolu, benzoin, co- 
pal, among the gums ; iodine, bromine, the organic alkaloids ; fixed 
and volatile oils, resins, and fats. In cases of poisoning by the inter- 



CHLOROFORM. 547 

nal administration of chloroform, the treatment should be conducted 
on the same plan as for irritant poisons. There is no chemical anti- 
dote. To overcome its effects on the respiratory and circulatory sys- 
tems, artificial respiration, cold affusion, and galvanism, may be em- 
ployed. 

Synergists. — Anaesthetic agents, opium, chloral, alcohol, etc., pro- 
mote the action of chloroform. 

Physiological Actions. — The taste of chloroform is hot, sweetish, 
and pungent. Undiluted it excites violent irritation and inflammation 
of the mucous membrane. In passing through the fauces the vapor 
may enter the larynx in such quantity as to cause great heat and in- 
flammation, followed by cedema. In the stomach, chloroform produces 
a feeling of warmth, followed by coldness, like ether ; but, when taken 
in large quantity undiluted, violent gastritis. Besides the local action, 
chloroform diffuses into the blood, and affects distant parts. Like 
alcohol and ether, it increases the action of the arterial system, and 
occasions excitement of the brain, followed by sopor. In lethal doses 
profound stupor and insensibility are produced by it. 

Therapy. — A little chloroform (in, ij — t\[ v), dropped on sugar and 
swallowed, will remove some kinds of nausea and vomiting. It can 
be useful in non- inflammatory states only, as, for example, sea-sickness, 
the vomiting of pregnancy, sick-headache, etc. Gastralgia may some- 
times be relieved in the same way. The following formula is an effec- 
tive remedy for flatulent colic : fy Spirit, chloroformi, tine, carda- 
momi comp., aa f ij. M. Sig. : A teaspoonful every half-hour in 
water. Hepatic and saturnine colic are also benefited by chloroform, 
but the addition of opium increases its efficacy, and is usually neces- 
sary in these cases. Chloroform is a solvent of biliary calculi, and 
has been prescribed with the view to effect a solution of calculi con- 
tained in the gall-bladder, or lodged in the hepatic duct. It undoubt- 
edly affords some relief, but not probably because of its solvent 
action. As has been remarked of ether, it is in the highest degree 
improbable that sufficient chloroform, even when it is administered in 
large doses, can reach the calculus to effect its solution, when experi- 
ments out of the body have shown that some hours are required to 
dissolve a calculus immersed in chloroform. In irritable ulcer of the 
rectum, and itching about the anal region, an ointment of chloroform 
gives great relief : IJ Ung. zinci oxidi, § j ; chloroformi, 3 j. M. Ft. 
ung. The vapor of chloroform may be applied directly to these parts. 

In hay-asthma, whooping-cough, spasmodic asthma, irritable reflex 
cough, the vapor of chloroform may be used as follows : To a cup of 
warm water, 80° to 100° Fahr., add a teaspoonful of spiritus chloro- 
formi, and repeat every five minutes. This inhalation should not be 
used except in the presence of a medical man, and not more than five 
teaspoonfuls should be inhaled at a time. The patient should inhale 



548 CEREBRAL SEDATIVES. 

the vapors as they arise, directing them into the air-passages from the 
cup by a paper shield. A little chloroform (a minim or two) is a use- 
ful constituent of expectorant mixtures, when a neurotic element is 
present. 

Chloroform is a very valuable hypnotic in delirium tremens. It is 
unsafe when used by inhalation in the treatment of this affection, but, 
by the stomach, not unfrequently excellent results are obtained from 
it. It is contraindicated when there are a vigorous action of the heart 
and an elevated state of the arterial tension, and useful when symp- 
toms of depression and adynamia are present. It should be given in 
the form of the spirit. IJ Spirit, chloroformi, tinct. capsici, aa f j. M. 
Sig. : A teaspoonful in water every half-hour, hour, or two hours. 

Neuralgia. — Chloroform is extremely valuable in the treatment of 
this disease, and it is the most effective when used by the method of 
" deep injection," first proposed by the author. This plan of treat- 
ment consists in the injection deeply, in the neighborhood of the 
affected nerve, of five to fifteen minims of pure chloroform. The offi- 
cial spirit of chloroform, ether, or even alcohol, may be used for this 
purpose. The first named, in the quantity of fifteen minims, is prob- 
ably the best. Rarely does any local mischief result from these in- 
jections, except a temporary induration. The author has procured by 
this means apparently permanent relief to long-standing cases of neu- 
ralgic pain (tic-douloureux) affecting the superficial divisions of the 
fifth. Other practitioners have been equally successful, and the cases 
thus treated now include neuralgic affections of the most important 
nerves. 

Pain in superficial nerves may sometimes be relieved by the local 
application of chloroform. fy Chloroformi, tinct. aconiti rad., aa 1 ss ; 
liniment, saponis, J j- M. Sig. : Liniment. A piece of flannel, moist- 
ened with this, is applied to the painful part, evaporation being pre- 
vented by a covering of oiled silk. 

An impending paroxysm of intermittent may be prevented by 
a full dose of chloroform (3j — 3 ij) administered before the onset 
of the chill. The inhalation of chloroform is used for the same 
purpose. 

A few drops of chloroform, frequently repeated, is an excellent 
means of relief in cholera. It allays nausea and vomiting, arrests 
diarrhoea, relieves the cramps, and restores the temperature. It may 
be given in the form of spiritus chloroformi, or of chlorodyne, a very 
celebrated empirical remedy. No single remedy has been more effica- 
cious than chlorodyne in the treatment of true cholera. 

It has been stated lately that chloroform has a curative effect in 
tape- worm. The following formula has been successful : fy Chloro- 
formi, 3 j ; crotoni olei, nij ; glycerini, f j. M. Take as a draught. 
(Persh.) 



CHLOROFORM. 549 

Chloroform as a Counter-irritant. — When chloroform is applied to 
the skin and evaporation prevented, it causes heat, redness, and even 
vesication. Frequently, chloroform is used locally to produce this 
effect, but usually in combination with other counter-irritants. ££ 
Chloroformi, ol. terebinthinae, aa § j ; lin. saponis, § ij. M. Sig. : 
Liniment. t> Chloroformi, lin. caraphorae, aa § j. M. Sig. : Lini- 
ment. These are elegant counter-irritant applications, in cases requir- 
ing the milder remedies of this class, and are used in various internal 
inflammations and local affections characterized by pain. Commercial 
chloroform can be used in preparing them. 

Chlorodyne. — This empirical preparation is largely used in cholera, 
and in painful diseases requiring an anodyne. Numerous formulae have 
been published, but none of them appear to possess the exact qualities 
of the original preparation by Dr. J. C. Browne. The dose of the 
genuine chlorodyne ranges from ten to thirty drops. The following 
formula makes a product more nearly resembling the original than any 
other known to the author : 

Chloroform 4 ounces. 

Ether 1 ounce. 

Alcohol 4 ounces. 

Treacle. 4 ounces. 

Extract of licorice 2J- ounces. 

Muriate of morphine 8 grains. 

Oil of peppermint 16 minims. 

Sirup lYi ounces. 

Acid, hydrocyan. dil 2 ounces. 

Dissolve the muriate of morphine and the oil of peppermint in the 
alcohol, mix the chloroform and ether with this solution, dissolve the 
extract of licorice in the sirup, and add the treacle ; shake these two 
solutions together, and add the hydrocyanic acid. Dose, five to fifteen 
minims. 

Some of the published formulae contain resin of cannabis Indica, 
atropine, perchloric acid, in addition to the ingredients above given. 

Another chlorodyne, known as "Gilman's," has many advantages, 
and is now widely used. Its composition is as follows : $ Chloro- 
formi purificati, 3 ij ; glycerini, § ij ; spts. vini rect., f ij ; acid, hydro- 
canic. dil., 3 ij ; tinct. capsici, 3 ij ; morphinae muriatis, gr. viij ; syrupi 
(treacle), J iij. M. The dose of this chlorodyne for an adult is a teaspoon- 
ful. In prescribing the various mixtures known by the common name — 
chlorodyne — the strength should be ascertained before administering. 

The following formulae (Fox) are very efficacious in the local affec- 
tions for which they are recommended : 

$ Chloroformi, t\[ vj ; cucumber cerate, § j. M. Sig. : Ointment 
for pruritus, fy Plumbi carbonat., 3 ss ; chloroformi, tti iv ; ung. 
aquae rosae, § j. M. Sig. : Ointment for pruritus. $ Chloroformi, 



550 CEREBRAL SEDATIVES. 

ii[ viij ; glycerin., 3 j ; ung. simplicis, 3 vj ; potassii cyanidi, grs. iv. 
M. Sig. : Ointment for pruritus. fy Morphinse acetat., 1 part ; chlo- 
roform, 8 parts ; lard, 60 parts ; oil of sweet almonds, 40 parts. M. 
An ointment to be applied several times a day in pruritus pudendi. 

Authorities referred to : 

Bartholow, Dr. Roberts. On the Deep Injection of Chloroform for the Relief of Tic- 
Douloureux. The Practitioner, July, 1874, p. 9. 

Fournier, Dr. H. Annuaire de Therapeutique, 1879, pp. 68-70. 

Fereol, Dr. Injections Sous-cutanees de Chloroforme. Annuaire de Therapeutique, 
1879, p. 68. 

Gubler, Dr. Adolph. Commentates Therapeutique du Codex Medicamentarius, p. 670. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
1S69. 

Trousseau et Pidoux. Traite de Therapeutique et Matiere Medicale, eighth edition. 

ANAESTHETICS AND ANAESTHESIA. 

iEther Fortior. — The stronger ether. 

Chloroformum Purificatum. — Purified chloroform. 

Neither of these anaesthetics should be used until its conformity to 
the standard of the United States Pharmacopoeia has been ascertained. 
The tests of purity are given under their respective heads in the pre- 
ceding article. 

The term anaesthetic, proposed by Dr. Oliver Wendell Holmes, 
means an agent capable of producing anaesthesia, or insensibility to 
pain. It is true, anaesthesia is a term which, according to its etymo- 
logical signification, should be applied to loss of sensation of touch, 
chiefly, and analgesia should be used to signify loss of the sense of 
pain ; but the word anaesthesia, as expressive of the state of profound 
unconsciousness induced by anaesthetics, is now so firmly established 
by usage that it were better to retain it. Insensibility to pain (anal- 
gesia) may be produced, without simultaneous loss of common sensation, 
touch (anaesthesia). By the inhalation of ether, chloroform, bichloride 
of methylene, nitrous oxide, and some other agents, the functions of 
animal life can be so far suspended that surgical operations involving 
intense pain, and certain natural processes, accompanied by great suf- 
fering, can be performed entirely without the consciousness of the 
subject concerned. 

Physiological Actions. — When the vapor of ether or chloroform 
is inhaled, a sense of faucial irritation and of the need of air is expe- 
rienced, and more or less cough is produced. The irritation of the 
fauces excites the flow of mucus, and the reflex act of swallowing. 
The feeling of need of air causes the patient to push aside the inhaler 
or sponge, and in children may lead to violent struggling. The sensi- 
bility of the glottis is soon diminished, the coughing ceases, and the 
inhalation then proceeds quietly. 



ANAESTHETICS. 551 

The first effect is a general exhilaration, the pulse increases in fre- 
quency, the respirations become more rapid, and sometimes assume a 
sobbing or convulsive character ; the face flushes ; talking, laughing, 
crying, singing, and sometimes praying, indicate the cerebral intoxica- 
tion. This stage of excitement varies in duration in different indi- 
viduals, and is more pronounced in character and more persistent in 
those of mercurial disposition, and in the hysterical. At this period, 
although the patient can be easily aroused, sensibility to pain is de- 
cidedly diminished ; although the sense of touch may be preserved, 
taste and smell are abolished, and the sight is either abnormally acute 
or is perverted by illusions. If the inhalation be continued, the patient 
passes into the condition of complete insensibility. In women and 
children, and males reduced by illness, the production of insensibility, 
if the anesthetic be not inhaled too rapidly, takes place quietly ; but, 
if the subject be a robust male, in full health, especially if the inhala- 
tion has been proceeded with rapidly, the stage of insensibility is pre- 
ceded by a tetanic convulsive stage, in which the voluntary muscular 
system and the respiratory muscles become rigid, the breathing ster- 
torous, the face cyanosed. This condition of rigidity is similar to, if 
not identical with, the tetanic stage of the epileptic paroxysm. If the 
inhalation of the anaesthetic be pushed still further, the tetanic rigidity 
subsides, the cyanosis disappears, the breathing proceeds quietly, and 
a condition of complete muscular relaxation, and of abolition of reflex 
movements, is established. When this is accomplished, the arm drops 
without resistance when let fall, the conjunctiva is insensible to irri- 
tation, the pupils do not alter in size when exposed to light, and no 
mechanical irritation awakens the least consciousness of pain. The 
surface is cool, and bathed with abundant perspiration, the counte- 
nance is placid, the eyes closed, the pupils rather contracted than di- 
lated ; the respiration easy, but more shallow than normal ; the pulse 
slower — it may be feebler, it may be stronger than in health. The 
functions of the cerebrum are suspended ; only the lower centers, pre- 
siding over respiration and circulation, continue in action. Out of this 
condition, and without interference, the patient will presently emerge. 
If, however, the inhalation be continued, these organic functions will 
be suspended, and life will be terminated by the cessation of the action 
of the heart and of the respiratory organs. 

There are several modes of dying from anaesthetic vapors : 
1. By the first mode, the death is sudden and occurs very soon 
after the inhalation has begun, and is ascribed to "irritation of the 
peripheral nervous system, accumulation of carbonic acid in the blood, 
and arrest of the action of the heart." This explanation, the author 
submits with diffidence, seems very unsatisfactory, for phenomena of 
this kind, up to the point of cardiac paralysis, must ensue in all cases 
of chloroform narcosis. The sudden death, at the beginning of inha- 



552 CEREBRAL SEDATIVES. 

lation, seems to be more properly explicable on the theory that the 
first chloroform vapor which reaches them paralyzes the cardiac gan- 
glia, already in an abnormal state of susceptibility from causes not 
now understood, for this accident sometimes occurs in persons who 
have previously taken the anaesthetic without unfavorable symptoms 
of any kind. 

2. By the second mode, called by Richardson epileptiform syncope, 
death ensues in the stage of rigidity preceding complete muscular 
relaxation, and is due to tetanic fixation of the respiratory muscles, 
and consequent interference with the pulmonary circulation, accu- 
mulation of blood on the venous side, and arrest of the heart's action. 
In these cases respiration ceases before the pulsations of the heart 
cease. 

3. By paralysis of the respiratory muscles. Death ensues during 
the stage of complete muscular relaxation, and the action of the heart 
continues for some seconds, or even minutes, after respiration has 
ceased. 

4. By paralysis of the heart. This also occurs in the course of 
complete insensibility ; the motor ganglia are paralyzed, and the heart 
suddenly ceases to act, the respiration continuing for a short time 
longer. 

5. This mode of dying is made up of two factors : depression of 
the functions by chloroform narcosis, and the shock of the accident, 
or the surgical operation. Death may ensue during the inhalation, 
or may occur afterward. 

Conditions or the Organism rendering the Use of Anaes- 
thetics dangerous. — Experience has demonstrated that old drunk- 
ards are peculiarly unfavorable subjects. When tumor or abscess of 
the brain exists, it is dangerous to administer anaesthetics. Instances 
of sudden death under these circumstances are relatively numerous. 
Very much enlarged tonsils, swollen epiglottis, oedema of the glottis, 
are contraindications, but not insuperable, to the use of anaesthetics. 
Emphysema of the lungs is so frequently accompanied by ischaemia 
of the arterial, and engorgement of the venous side of the systemic 
circulation, and with dilatation of the right cavities, that it must be 
considered a dangerous state in which to administer chloroform, or 
even ether. Fatty change in the muscular substance of the heart 
must be considered peculiarly unfavorable, for more deaths have en- 
sued from this cause than any other. 

Chloroform and ether have been administered with safety in cases 
of phthisis and heart-disease (valvular lesions), the muscular substance 
and its contained ganglia being free from structural change. 

Experience has abundantly demonstrated that those reduced by 
illness and disease, and the feeble, bear anaesthetics better than the 
healthy and robust ; that children and women are better subjects than 



ANAESTHETICS. 553 

adults and men ; that anaesthetics are safer when given for operations 
for disease than for injury. 

Incomplete anaesthesia is a condition of danger. Numerous acci- 
dents have occurred from the use of anaesthetics for trivial operations 
— notably for extraction of teeth — in which but a partial degree of 
insensibility is induced. In such cases the heart, enfeebled by chloro- 
form narcosis, is suddenly paralyzed by the reflex action proceeding 
from the peripheral injury. The district of tissue supplied by the 
fifth nerve is an especially dangerous region, owing doubtless to the 
intimate connection of the nucleus of the fifth with the nucleus of the 
pneumogastric. By far the largest number of fatal cases have resulted 
from a neglect of this rule : it is never safe to proceed in a surgical 
operation with anaesthetics, unless complete insensibility has been pro- 
duced. The author is aware that Trousseau and Pidoux have attrib- 
uted the number of cases of fatal chloroform narcosis, which have 
occurred in England, to the fact that the just-mentioned rule is ad- 
hered to by English surgeons. Their words are as follows : " En 
Angleterre, les chirurgiens portent V etherisation jusqu'd V abolition de 
toutes les facultes animates, jusqu'au commencement de la periode 
d'etherisme organique. Plus prudents sous ce rapport que leurs con- 
freres de la Grande- Br etagne, les chirurgiens franpais ont V habitude 
de s'arreter des que la sensibilite aux excitations de la peau est abolie 
et que la resolution musculaire commence. Cette prudence explique 
comment les chirurgiens franpais ont eprouve moins d ''accidents graves 
et compte moins de morts subites." (Yol. ii, p. 322.) 

Modes of conducting the Inhalation. — After ascertaining that 
none of the contraindications mentioned above exist, the patient may 
be prepared for the inhalation of the anaesthetic vapor. The inhala- 
tion should not be proceeded with soon after a full meal. Vomiting, 
as the narcosis subsides, is usual, and, as the insensibility of the glottis 
persists for some time afterward, particles of food may be lodged in 
the chink, causing fatal suffocation. Several cases of this kind have 
been reported. On the other hand, it is bad practice to administer 
an anaesthetic after a prolonged period of fasting, for the exhaustion 
thereby induced may be an influential factor in determining a fatal 
result. Before the inhalation is begun, it is proper to administer an 
ounce or two of whisky or brandy. Much more important is the ex- 
pedient proposed by Bernard and afterward by Kussbaum, to premise 
a subcutaneous injection of morphine. Bernard proposed to administer 
the morphine before beginning the inhalation ; whereas Nussbaum 
used it after unconsciousness to pain had been produced. The ad- 
vantages of the former method are obvious. When the morphine 
influence takes place, the inhalation will proceed quietly without the 
struggling and coughing, and spasmodic breathing, which so interfere 
with the administration of anaesthetics, especially of ether. The use 



554 CEREBRAL SEDATIVES. 

of morphine subcutaneously also lessens materially, if not prevents 
entirely, the stage of rigidity and spasm. The quantity of the anaes- 
thetic required is much less, and the stage of insensibility more pro- 
longed, when morphine is thus given. 

Besides the foregoing conspicuous advantages derived from the 
preliminary subcutaneous injection of morphine, there can be no doubt 
that this agent antagonizes the paralyzing action of the anaesthetic on 
the cardiac and respiratory centers, and prevents the subsequent shock 
due to the administration of the anaesthetic and the performance of a 
surgical operation. 

The proposal of Bernard, as subsequently advocated by Nussbaum, 
was some time afterward strongly urged by the late Prof. William 
Warren Greene, M. D., of Pittsfield, Massachusetts, and Dr. J. C. 
Reeve, of Dayton, Ohio. Soon after the publication of Bernard's 
observations, the author, in his "Manual of Hypodermatic Medica- 
tion," proposed the use of morphine and atropine combined as more 
perfectly realizing the object contemplated. Since this time, at Lyons, 
the combination of morphine and atropine has been largely employed 
preliminary to ether inhalation. The method is known as "anesthe- 
sies mixtes" or, anaesthesia by a mixed method (Aubert). The addi- 
tion of atropine is to increase the forces of the antagonism against the 
depression of the cardiac and respiratory functions. The experience 
of the Lyons school is decidedly in favor of the method of mixed an- 
aesthesia. Adverse reports from other quarters, however, have not 
been wanting, but the relevancy of their facts is doubtful. 

When the anaesthetic is about to be administered, the^ operator 
should, by a cheerful and confident manner, remove the fears of the 
patient. None of the paraphema of the operation to be performed 
should be exhibited before the patient, and no remarks should be made 
in his hearing regarding his case, the anaesthetic sleep, or the surgical 
procedure. Only the physician having the administration of the an- 
aesthetic in charge, and the necessary assistants, should be present in 
the apartment. An abundant supply of fresh air should be insured 
to the patient, and all the appliances required for resuscitation should 
be at hand, but not ostentatiously paraded before the patient. 

The simplest apparatus only is required. Complicated inhalers 
have, as frequently as the towel or the handkerchief, been used in 
fatal cases of chloroform narcosis. A cone of stiff paper, lined with 
lint or felt, and large enough to cover the nose and mouth of the 
patient, is the best form of inhaler for the administration of ether. 
Lente's ether-inhaler consists of a cone of hard rubber lined with felt, 
and having attached to the apex a flexible rubber tube communicating 
with the ether-bottle. This is a very satisfactory apparatus. A simi- 
lar but much less complicated and expensive inhaler is that of Dr. Allis, 
of Philadelphia. The utility and desirableness of this apparatus are 



ANESTHETICS. 555 

much commended by Prof. William Goodell. When ether is inhaled, 
the atmosphere is, as far as possible, excluded, in order that the anaes- 
thetic effect may be quickly induced. The important point in the 
administration of chloroform is to secure such an admixture of atmos- 
pheric air as that the amount of chloroform-vapor shall not exceed 
three and a half per cent. If this rule be regarded, the form of in- 
haler is of little importance. The original method of Simpson con- 
sisted in applying the vapor by dropping slowly chloroform on a piece 
of thin cloth laid over the mouth and nose, or by a linen handkerchief 
moistened with half a drachm. The mouth and nose should be pro- 
tected from the irritant action of the chloroform by inunction with oil. 

A cone made of a towel, having a large opening at the apex, and 
containing a suitable, very porous sponge, is now probably more em- 
ployed than any other form of inhaler for giving chloroform. The 
typical method for administering it is that of Snow : in a bag of suit- 
able size the vapor of chloroform is mixed with air in the proper pro- 
portion, and then given directly ; but, obviously, such an arrangement 
is not often available. 

In administering the vapor of chloroform by any of the modes in 
use, it should not be forgotten that it has a density and weight four 
times those of air, and that, consequently, when a cloth or handker- 
chief is held closely over the mouth, the air is displaced, and the pa- 
tient may be breathing little more than chloroform-vapor. During 
the administration of ether, attention should be directed to the state 
of the respiration, for arrest of the respiratory movements is the only 
source of danger. When chloroform is being inhaled, the state of the 
circulation, as well as of the respiratory apparatus, must be regarded. 

Means of removing Dangerous Symptoms. — Suspension of the 
heart's action is to be met at once by the withdrawal of the vapor, 
and the inversion of the patient, according to the method of Nelaton ; 
failure of respiration, by forcibly drawing out the tongue, by the 
practice of artificial respiration, and by faradization of the respiratory 
muscles. Artificial warmth should be applied, and cooling of the body 
by cold-water douche, etc., should be prohibited. Acupuncture of the 
heart, galvano-puncture, injection of ammonia into the veins, are meas- 
ures which have been used in extreme cases, but unfortunately rarely 
with success. Amyl nitrite, by inhalation or subcutaneously, has 
proved very useful in some cases. Schirmer arouses patients by irri- 
tating the nasal mucous membrane by means of a roll of paper of suit- 
able size, and this may be made more exciting by dipping the end in 
aqua ammonia. Alcoholic stimulants — whisky or brandy — have often 
been used hypodermatically with asserted advantage. At the present 
time the subcutaneous injection of ether is the popular expedient. It 
is, however, very questionable whether the administration of alcohol 
or one of its derivatives can be useful in a condition of things brought 



556 CEREBRAL SEDATIVES. 

about by an anaesthetic of alcoholic origin. The author believes, in- 
deed, that serious mischief is done by this practice in cases capable of 
resuscitation. 

In practicing resuscitation for arrest of breathing due to ether, 
artificial respiration by the method of Silvester, faradization of the 
chest-muscles, and inversion of the body by the method of Nelaton, 
are the most promising expedients. 

Therapy. — Anaesthetic agents are 'used to quiet pain and spasm 
from disease, to render the dressing of injuries and surgical operations 
painless, and to produce muscular relaxation. Ether-inhalations give 
entire relief to the pain of neuralgia (tic-douloureux), cancer, and in- 
flammation • to pain dependent on spasms — tetanus, chorea, hepatic 
and nephritic colic, etc. It is not necessary in these cases, as a rule, 
to induce full anaesthesia, for, as has already been pointed out, the 
sensibility to pain ceases before the condition of insensibility is reached 
— before, indeed, the perceptive centers of conscious impressions are 
otherwise impaired than as to the appreciation of pain. Paroxysms of 
maniacal delirium, and of puerperal mania, when violent and uncon- 
trollable, are sometimes quickly quieted and refreshing sleep obtained, 
from which the patient eventually arouses in a calmer frame of mind. 
Ether is the proper agent for this purpose. It should not be forgotten 
that anaesthetics are dangerous in delirium tremens. 

In puerperal convulsions due to reflex irritation, or to urmmia, the 
use of chloroform is invaluable. It is equally effective in the reflex con- 
vulsions of early life, in the urwmic convulsions of scarlet fever, and 
in the so-called hystero-epilepsy. When puerperal or other forms of 
convulsive seizures are due to cerebral haemorrhage, no good can be 
accomplished by anaesthetic inhalations. In any case, although con- 
vulsions may be arrested by anaesthetic inhalations, other appropriate 
measures must be resorted to for the permanent removal of the causes. 
A paroxysm of epilepsy impending may be aborted by the inhalation 
of ether, but the nitrite of amyl is a more effective remedy for this 
purpose. 

In certain neuroses of the respiratory organs, great relief is ob- 
tained by anaesthetic inhalations. Laryngismus stridulus may be 
quickly cured by the vapor of chloroform. A few drops of chloroform 
on a handkerchief will suffice, and special care should be taken to dilute 
the vapor largely with air. A similar procedure will relieve severe 
paroxysms of whooping-cough, but a more energetic use of chloroform 
is required when convulsions occur during a fit of coughing. No single 
agent gives more relief in asthma, but, like all other remedies for this 
disease, the power of relief declines, and increasing doses of the anaes- 
thetic become necessary, so that the habit of chloroform or ether nar- 
cosis is formed. 

Anaesthetic inhalations should not be recommended in cases which 






ANAESTHETICS. 557 

will probably require their use for a long time, because the inclination 
for this kind of intoxication grows rapidly, and is as difficult to control 
as the opium-habit. The author has seen one case in which the patient 
consumed a pound of chloroform daily, but, as might be expected, this 
extraordinary consumption of the anaesthetic did not long continue, for 
the patient succumbed in a few months. 

In obstetric practice the applications of anaesthetics are numerous 
and important. The indications and contraindications for chloroform 
in natural labor may be formularized as follows : When the labor is of 
short duration, and not excessively painful, anaesthetics should not be 
used ; on the other hand, when the labor is protracted and the suffering 
great, they favor the progress of the case and prevent exhaustion and 
uterine inertia. In primipara caution is necessary. The inhalation of 
the anaesthetic should not begin until near the close of the first stage, 
unless those painful but ineffectual contractions occur which have been 
aptly characterized as "nagging pains," when the vapor, very much 
diluted, may be cautiously inhaled for their relief. The inhalation 
should be practiced only during the existence of the pain. The influ- 
ence of the anaesthetic on the pulse, respiration, and uterine contrac- 
tions, should be carefully observed, and, if the pulse fail, the respirations 
become shallow, or the pains lose in efficiency, the inhalation should be 
discontinued. If the anaesthetic cause great excitement, and the patient 
become loudly clamorous for more, while the uterine contractions are 
lessening in force, it is doing harm and should be withdrawn. It is 
never necessary, nor proper, to administer the anaesthetic to complete 
unconsciousness. Toward the close of the second stage, when the head 
begins to distend the external parts, the quantity of chloroform may be 
somewhat increased, but the inhalation should be discontinued when 
the occiput has passed under the pubic arch. If these rules are fol- 
lowed, the action of the anaesthetic is beneficent. Properly adminis- 
tered, the use of chloroform may be considered perfectly safe in the 
parturient female. It is generally conceded that no well-authenticated 
case of death from the use of chloroform in labor has occurred, when the 
administration was in the hands of a properly-qualified medical man. 

The following evil results, the author believes, have followed the 
incautious use of anaesthetics in labor : the progress of the case arrested, 
so that forceps became necessary ; slow and imperfect uterine contrac- 
tions, and consequent post-partum haemorrhage ; a toxic condition of the 
mother's blood, with after - excitement, wakefulness, and puerperal 
mania ; asphyxia of the child, tedious convalescence, and subinvolution 
of the womb. 

When instrumental delivery is required, the utility of anaesthetics 
is unquestionably great. It facilitates the necessary manipulations, and 
prevents shock. The inhalation should be carried far enough in these 
cases to produce sufficient quietude in the patient, and it may be to 



558 CEREBRAL SEDATIVES. 

complete muscular resolution. When turning is to be performed, the 
state of chloroform narcosis must be deep enough to suspend uterine 
contractions. 

If puerperal convulsions occur at any stage, the utility of chloro- 
form is unquestionable. The limits of its utility in these cases have 
already been indicated. 

When careful examination of the pelvic viscera is to be made to 
establish the diagnosis in difficult and obscure cases, as, for example, 
phantom tumor, ovarian and fibroid growths, pelvic abscess, etc., the 
importance of full anaesthesia can hardly be over-estimated. 

The use of anaesthetics in operative surgery is now an indispensable 
practice. It may be compendiously stated that ether, or chloroform, 
is required in all surgical operations of magnitude, for the reduction of 
dislocations, for the taxis in strangulated hernia, for dressing painful 
wounds and adjusting fractures, for breaking up adhesions, and con- 
tractions of muscles and tendons in cases of deformity, for establishing 
the diagnosis in feigned diseases, etc. 

The after nausea and vomiting, which are sometimes most depress- 
ing, and occasionally dangerous, produced by anaesthetics, may be pre- 
vented by the hypodermatic injection of morphine and atropine before 
beginning the administration of the anaesthetic. After the patient 
emerges from the anaesthetic sleep, the above-mentioned unpleasant 
after-effects may be relieved by a minute quantity of morphine (y 1 ^ of 
a grain) and atropine (yj-g- of a grain) injected subcutaneously. 

Comparative Utility of Ether and Chloroform. — Chloroform 
is more pleasant to inhale, and is less irritant to the air-passages than 
ether. The vapor of chloroform is not, and the vapor of ether is, in- 
flammable, whence it follows that the former may be alone admissible 
at night under some circumstances. The stage of excitement is longer 
from ether than from chloroform, but, as ether may be given much 
more rapidly, this difference in action may be made to disappear in 
practice. Chloroform is more prompt in its effects, and the narcosis 
induced by it more sustained, than is the case with ether ; but these 
advantages possessed by chloroform are quite balanced by the greater 
freedom with which ether may be administered. The danger from 
the inhalation of chloroform is vastly greater than from ether. 

It follows from the above considerations that ether should be used 
in preference to chloroform in all cases, except during labor. Chloro- 
form is to be preferred in labor, because more pleasant to inhale, more 
prompt in action, and without inflammability. The consideration of 
safety must necessarily take precedence, but experience has shown 
that chloroform is perfectly safe in labor when properly administered. 

The frequency with which fatal cases of chloroform narcosis have 
been reported — amounting in the aggregate now to about five hun- 
dred — imposes an immense responsibility on the administrator. In the 



ANESTHETICS. 559 

present state of opinion on the subject, the use of chloroform, when 
ether is available, for the production of anaesthesia, can hardly be jus- 
tified, especially if a fatal result follow its administration. 

Ethyl Bromide. — The physical properties of this ether are men- 
tioned on another page in connection with ether. As an anaesthetic, 
it was first known to Mr. Nunnely, of Leeds, and he first employed it 
in surgical practice in 1865. Dr. Turnbull gave an account of its prop- 
erties, based on experimental and clinical evidence, in 1877, but the 
most extended trials of its anaesthetic powers were made by Dr. Levis, 
of Philadelphia, in 1879-'80. In the latter year two unsuccessful 
cases occurred, one in the hands of Dr. Levis, its chief promoter, and 
the other in the practice of Dr. Marion Sims, of New York. These 
fatal cases, and some crude physiological experiments, undertaken to 
prove that ethyl bromide is a heart-paralyzer, started a reaction against 
this anaesthetic, then beginning a promising career, and in a short time 
it fell into almost complete disuse. It has, however, valuable properties 
which should preserve it from neglect. To induce complete insensi- 
bility, from four to six grammes ( 3 j — 3 jss) must be administered rap- 
idly. The odor is not unpleasant, and but little irritation of the air- 
passages is produced. If administered in full quantity, there is a very 
brief (scarcely noticeable) stage of excitement, and the period of rigid- 
ity is very short and not pronounced. The face is flushed, the ears 
red, the eyes injected, and the pupils are more or less dilated. The 
action of the heart is accelerated, and the pulse increases in force. 
The respiration is also somewhat quickened, and in some subjects be- 
comes snorting or stertorous, but irregularity or arrest of the respira- 
tory movements has not occurred. More or less embarrassment of 
breathing has been occasionally caused by an accumulation of bron- 
chial mucus. It does not often induce nausea and vomiting ; but 
women are more apt to be disturbed in this way than men. The du- 
ration of the stage of insensibility is brief and the awakening prompt, 
with little of the confusion of mind and excitement characteristic of 
ether and chloroform. As a rule, the patient wakes out of the anaes- 
thetic condition with little distress of any kind. 

In the fatal cases recorded, there are strong doubts in regard to 
the share of ethyl bromide in the result. In Dr. Levis's case the pa- 
tient was far advanced in pulmonary disease, and was unfit for the 
administration of any anaesthetic. In Dr. Sims's case the death of the 
patient occurred a number of hours after the operation, which was a 
tedious one, requiring very protracted use of the anaesthetic. It is said 
that a strong odor of bromine pervaded the entire body of this sub- 
ject. It is, however, in a high degree improbable that decomposition 
of the ethyl bromide takes place when it is inhaled. 

In administering this anaesthetic the method pursued with ether is 



560 CEREBRAL SEDATIVES. 

best. If given promptly, in sufficient quantity, and but slightly di- 
luted with air, the stage of insensibility can be induced in about five 
minutes (Levis). It is not suited to operations requiring much time. 
It is, however, peculiarly well adapted for slight or brief operations 
of a very painful character, and for ophthalmic practice it is unequaled, 
according to Chisolm. 

M. Perier states that he has used ethyl bromide very often as a 
local anaesthetic, instead of ether, and, he affirms, with great success. 
The method to which he refers is local anaesthesia as inaugurated by 
Richardson with the spray -douche. Among other distinct advantages 
over ether, ethyl bromide is not inflammable, and can consequently be 
used under circumstances prohibiting the former. 

The inhalation of ethyl bromide has been utilized in the treatment 
of diseases for the relief of which the bromides have been given by 
the stomach. MM. Bourneville and Oilier have carefully investigated 
this action of ethyl bromide in hysteria and epilepsy. They find that 
hysterical seizures are promptly arrested, and that in epilepsy the 
daily administration of this remedy during a period of two or three 
months notably diminishes the frequency of the attacks. This prac- 
tice might be advantageously extended to the treatment of severe chorea, 
whooping-cough, spasmodic asthma, hepatic and renal colic, etc. For 
these purposes, only sufficient ethyl bromide is inhaled to relieve the 
pain or spasm, or to induce sopor. 

Bichloride of Methylene. — This agent, similar to chloroform, was 
first proposed as an anaesthetic by Dr. B. W. Richardson. It is more 
agreeable to inhale, and less apt to produce after-sickness, than chloro- 
form, but it is not less, and probably more, dangerous to life. Five or 
six deaths have occurred in the cases in which methylene bichloride 
was administered. Spencer Wells has constantly used it since it was 
introduced, without a single untoward result. But he employs a spe- 
cial administrator, and gives the vapor with a regulated supply of air. 
His apparatus consists of a mask closely fitting over the mouth and 
nose, connected by a flexible tube with a bottle containing the anaes- 
thetic, and with a rubber hand-ball, which sends into the mask, with 
every contraction of the bulb by the hand, this quantity of air with 
the anaesthetic vapor. As no accidents have happened, and yet pa- 
tients are kept narcotized for hours at a time, there can be no doubt 
of the security afforded by this method of conducting the inhalation. 
It were well if this plan were applied to the inhalation of chloroform 
as well as bichloride of methylene. 

Authorities referred to : 

Anstie, Dr. Francis Edmttnd. Stimulants and Narcotics, American edition. 
Aubert, Dr. M. P. Anesthesies mixtes par r ether, la morphine et V atropine. Lyon Medi* 
cale, January 14, 1883. 



ANESTHETICS. 561 

Boettcher, Prof. Dr. A. Ueber die Wirkung des Chloroforms auf das Blut. Vir- 
chow's Archiv, xxxii, 1865, p. 126. 

Brinon, de, Dr. II. Anesthesie mixte par le chloroforme et la morphine. Ann. de 
Therap., 1879. 

Gubler, Dr. A. Commentaires Therapeutiques du Codex Medicamentarius, etc., p. 670. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 1034. 

Kohler, Dr. Hermann. Chloroform, Aether und die als Ersatzmittel des Chloroform 
empfohlenen Alkoholderivate zusammengestelle und besprochen. Schmidfs JahrbiXcher, vol. 
cxlii, p. 209, and vol. cxlv, p. 305. 

Lente, Dr. Frederic D. New York Medical Journal, vol. viii, p. 615. 

Hedico-Chirurgical Transactions. Report of the Committee, etc., to inquire into the 
Uses and the Physiological, Therapeutical, and Toxical Effects of Chloroform, etc., vol. 
xxix, second series, p. 323. 

Morgan, Dr. J. The Danger of Chloroform and the Safety and Efficiency of Ether, 
London, 1872. 

Nothnagel, Dr. Hermann. Die fettige Degeneration der Organe bei Chloroformvergif- 
tung. Berliner klinische Wbchen., iii, 4, 1866. 

Ibid. Handbuch der Arzneimittellehre, p. 125. 

Petrequin, Dr. J. E. Nouvdles Recherches sur la Choix d faire entre la Chloroforme 
et V Ether red., etc. Gaz. Heb , 4-6, 1867. 

Reeve, Dr. J. C. American Journal of Medical Sciences, October, 1867. 

Richardson, Dr. B. W. TJie Medical Times and Gazette, 1866-1871, various articles. 

Sansom, Dr. Arthur Ernest. Chloroform : Its Action and Administration, Phila- 
delphia, 1866. 

Simpson, Sir J. Y. Anaesthesia, Hospitalism, etc., Works, American edition. 

Snow, Dr. On Chlorofoi-m and other Anaesthetics, London, 1858. 

Squibb, Dr. E. R. New York Medical Journal, April, 1871. 

Trousseau et Pidoux. Trait'e de Therapeuiique et de Matiere Medicale, eighth edition, 
vol. ii, p. 301. 

Verriet-Litardiere, Dr. These de Paris, 1879. Anesthesie mixte par le chloroforme 
et la morphine. 

Authorities for ethyl bromide : 

Chisolm, Prof. J. J., M. D. Maryland Medical Journal, vol. ix, No. 32. 

Duval, Dr. M. A. These de Paris, 1881. Bromure d'ethyle comme anesthesique. 

Levis, Dr. R. Ethyl Bromide as an Anaesthetic. The Medical Record, New York, 
March 27, 1880. 

Nunnely, Mr. Thomas. Transactions of the British Mediccd Association for 1865. 

Perier, Dr. Annuaire de Iherapeutique pour 1881, p. 62. 

Terrillon, Dr. Bromure d'ethyle comme anaesthesique. Annuaire de Therapeutique 
pour 1881. 

Turnbull, Dr. L. Artificial Anaesthesia, Philadelphia, 1882. 

Local Anaesthesia. — The diminution of the cutaneous sensibility, 
by the application of ice and freezing mixtures, has long been practiced. 
It was not, however, until Richardson's method by the hand-ball spray 
apparatus had been proposed, that there had been much use made of 
local anaesthesia. 

This method consists in directing a current of atomized ether 
against the part to be anaesthetized. The ether employed for this 
37 



562 CEREBRAL SEDATIVES. 

purpose should have a specific gravity not to exceed 0*723. Rhigolene, 
the lightest liquid known, a product of the fractional distillation of 
petroleum, is more effective than ether, but great difficulty attends its 
use, owiug to its extreme volatility. When a current of atomized 
ether or rhigolene is directed against the skin, the rapid evaporation 
produces an intense degree of cold, in consequence of which the nerves 
lose their power of transmitting impressions to the sensorium. 

A serious drawback to the process of producing local anaesthesia 
is the unpleasant burning which follows in the part when it recovers 
from the freezing, and also the great pain which attends the applica- 
tion of ether-spray to certain parts. 

Therapy. — For small operations, such as extraction of teeth and 
opening abscesses, the method of local anaesthesia is extremely useful. 
It has been and can be used with entire success in much larger opera- 
tions, but it is generally employed for merely minor ones. 

The application of ether-spray to the spine is an extremely service- 
able remedy in spinal irritation and in chorea. In the latter disease 
it alone suffices to effect a cure. In neuralgia of superficial nerves, 
lumbago, muscular rheumatism, etc., the ether-spray affords relief very 
quickly, which may be permanent. 

Nitrons Oxide. — Protoxide of nitrogen. Laughing-gas. 

Composition and Properties. — A colorless, inodorous gas, having 
a slightly sweetish taste, and a specific gravity of 1*527. It consists 
of one equivalent each of nitrogen and oxygen. It increases the rate 
of combustion of inflammable substances. Water at ordinary temper- 
ature absorbs about three fourths of its bulk of the gas. By pressure 
and cold the gas may be condensed into a liquid, and can then be stored 
up in suitable vessels for transportation and use. The quantity of the 
gas taken up by cold water may be much increased by pressure, and 
the water will then yield it up on heating. Hence this constitutes a 
convenient mode of storing the gas for preservation. The ordinary 
mode of storing the gas is in gas-bags holding about eight gallons, in 
gasometers, or in the liquid form in strong metallic casks. 

Physiological Actions. — The first surgical operation performed 
with a modern anaesthetic was the extraction of a tooth, the* subject 
being unconscious from the inhalation of nitrous oxide. It had long 
been known that this gas produced decided exhilaration when inhaled 
to a certain point. It has a very short anaesthetic stage, unless the in- 
halation of the gas be continued. 

The first effect of the inhalation of nitrous oxide is a subjective 
■dizziness, whirring noises in the ears, and tingling and loss of sensa- 
tion throughout the body. Extraordinary illusions beguile the senses, 
and the intoxicated subject suddenly breaks forth into singing, decla- 
mation, sobbing, melancholy, or manifests a pugnacious tendency and 



NITROUS OXIDE. 563 

assaults those about him. As the effects quickly cease, and as the 
return to consciousness is very abrupt, the subject is surprised and 
ashamed to find himself in some ridiculous or grandiose position quite 
foreign to his usual demeanor. 

When used to produce anaesthesia for surgical operations, the inha- 
lation of the gas is forced, and the stage of excitement is very brief. 
The countenance assumes a frightful aspect, most alarming to those 
who have not witnessed the inhalation of the gas. The face becomes 
deadly pale, the respirations, at first shallow, soon assume a stertorous 
character, the jaw becomes fixed, the eyes protrude, and the pallor of 
the face is presently replaced by a bluish and purplish tint. 

So far as the exterior phenomena can afford any indication of the 
nature of the action, the condition produced by nitrous oxide is an 
asphyxiated state. The blood ceases to be oxygenated, carbonic acid 
accumulates, and the centers of conscious impressions are rendered in- 
active in consequence of the deficient supply of oxygen and the excess 
of carbonic acid. The rational indications of the nature of the narcosis 
produced by nitrous oxide are confirmed by physiological experiment. 
It has been found that the exhalation of carbonic acid is decidedly 
diminished by the inhalation of nitrous oxide, and that animals live no 
longer in an atmosphere of this gas than in an atmosphere of nitrogen. 

The inhalation of nitrous oxide appears to be almost free from 
danger, and it is rare that unpleasant after-effects follow its adminis- 
tration. Two fatal cases have certainly occurred, which can with pro- 
priety be attributed to the lethal action of this gas, and various cases 
have fallen under the observation of the author in which nervousness, 
vague mental symptoms, and headache, have been experienced after 
the inhalations. 

Theeapy. — The very prompt action of nitrous oxide and the quick 
subsidence of the narcosis render it a very useful anaesthetic agent 
when small operations, quickly executed, are to be performed. It is 
especially adapted for the extraction of teeth, opening of abscesses, and 
similar minor operations. But it has also been used successfully for 
maintaining prolonged anaesthesia for the performance of capital oper- 
ations. There is no difficulty in keeping up insensibility from fifteen 
minutes to a half-hour, since the introduction of liquefied gas and of 
apparatus for its suitable application. 

Authorities referred to : 

Amory, Dr. Robert. The Physiological Action of Nitrous Oxide. New York Medical 
Journal, August, 1870. 

Johnson, Dr. George. A Lecture on the Physiology of Coma and Anaesthesia. Medi- 
cal Times and Gazette, April 3, 1869. 

Jolyet et T. Blanche, MM. Recherches experimental sur V Action du Gaz protoxyde 
d' 1 Azote. Bulletin General de Therap., vol. lxxxv, p. 91. 

Richardson, Dr. B. W. Medical Times and Gazette, vol. i, 1868. 



564 CEREBRAL SEDATIVES. 

Chloral. — Chloral. Hydrate of chloral. Chloral, Fr. ; Chloralhy- 
drat, Ger. 

Separate, rhomboidal, colorless and transparent crystals, slowly 
evaporating when exposed to the air, having an aromatic, penetrating, 
and slightly acrid odor, a bitterish, caustic taste, and a neutral reaction. 
Freely soluble in water, alcohol, or ether ; also soluble in four parts of 
chloroform, in glycerin, benzol, benzin, disulphide of carbon, fixed or 
volatile oils. It liquefies when mixed with carbolic acid and camphor. 

Dose, grs. v — 3j, or more, but it should not be forgotten that 3 ss 
has produced toxic symptoms. 

Antagonists and Incompatibles. — The depression of the heart 
and respiration caused by chloral is antagonized by alcoholic stimu- 
lants, ammonia, atropine, by galvanism, and by artificial heat. These 
are, therefore, appropriate remedies to be employed in cases of poison- 
ing. Strychnine is held by Liebreich to be antagonistic, and hence it 
may be administered hypodermatically when the measures above men- 
tioned are being used. 

Alkalies decompose chloral with the production of formic acid and 
chloroform, hence all agents having an alkaline reaction are incompat- 
ible. 

Synergists. — The hypnotic medicines, notably opium, and the an- 
aesthetics, deepen the effects of chloral when they are simultaneously 
administered. 

Physiological Actions. — Chloral has considerable antiseptic prop- 
erty, and is preservative of animal textures. It produces redness and 
inflammation of the skin, when kept in contact with it for a lengthened 
period. The taste of chloral is hot and pungent, and it excites an 
abundant flow of saliva. In the stomach it causes first a cooling sen- 
sation, followed by warmth, and when taken in large quantity may set 
up a high degree of gastric irritation, nausea, and vomiting. In mod- 
erate quantity chloral rather stimulates than impairs the appetite, and 
indigestion and nausea do not, as a rule, follow as an after-effect. 

Chloral diffuses into the blood rapidly. The changes which occur 
after its entrance into the vessels are much disputed. Liebreich, as is 
well known, was led — by observing the reaction when chloral is brought 
into the presence of an alkali — to the deduction that the soda of the 
blood would split up chloral into chloroform and formic acid, and that, 
therefore, the effects belonging to chloroform might be produced by the 
administration of chloral. It is probably true that this reaction does 
take place to some extent, but there are several insuperable objections 
to the theory of Liebreich : 

1. The effects of chloral differ from those produced by a corre- 
sponding quantity of chloroform. 

2. After the administration of chloral, there is no elimination of 
chloroform by the breath or urine. 



CHLORAL. 565 

3. Chloral is more decidedly hypnotic, and much less anaesthetic, 
than chloroform. 

4. Crystals of chloral have been recognized in the blood, and the 
products of the decomposition of chloral have recently been recovered 
from the urine. 

The effects which follow an ordinary medicinal dose (fifteen to 
thirty grains) are not the same in all subjects, although it must be 
admitted that a great degree of uniformity exists. When there is 
present an insusceptibility to its hypnotic action it produces headache, 
and in some subjects a delirious excitement. Immediately preceding 
its hypnotic action there is developed in all subjects a stage of excite- 
ment, usually very short in duration, and followed by sudden and 
complete sopor. The sleep produced by chloral is extraordinarily 
like natural sleep, and is calm, dreamless, and refreshing. It is not a 
condition of narcotism, and the patient may be easily aroused to take 
food and nourishment, and will quickly and without difficulty fall 
asleep again. As a rule no unpleasant after-effects are experienced 
from a dose of chloral — no headache, faintness, giddiness, nausea, and 
constipation, so common after morphine. The quantity of chloral ne- 
cessary to produce sleep, without dangerous narcotism, ranges from 
fifteen to forty grains, and the duration of the effect varies in differ- 
ent subjects from two to eight hours. Chloral does not destroy the 
sensibility to pain, unless administered in a quantity sufficient to sus- 
pend the functions of the cerebrum. It is not a pain-relieving agent 
in the sense that morphine is. 

When sleep is produced by proper medicinal doses of chloral the 
pupil contracts a little, the pulse may remain unaltered or become 
slower, and the respirations are unaffected. When a dangerous or 
lethal dose is taken, profound narcotism will follow ; the respirations 
will be slower and shallower, the pulse will become weak, rapid, and 
irregular ; sensibility and the reflex movements will be abolished, and 
complete muscular relaxation will ensue. The mode of dying is by 
suspension of the functions of the cerebrum, and, finally, by paralysis 
of the respiratory center, and of the cardiac motor ganglia. Death 
may be suddenly produced by paralysis of the heart, in cases of fatty 
degeneration of the muscular tissue of this organ, without proceed- 
ing so far as to involve the lower centers of the brain. 

A marked reduction in temperature, notably in rabbits — so much 
as 8° Fahr. — is produced by chloral, but this effect may be considera- 
bly lessened by enveloping the body in non-conductors (Brunton), 
which act by preventing the cooling of the blood by the atmosphere. 
The first effect of chloral is to raise the arterial tension (stage of 
excitement), but this action quickly ceases, and a decided lowering of 
the tension results. The diminished arterial tension and the weak- 
ened action of the heart are the principal factors in the reduction of 



566 CEREBRAL SEDATIVES. 

the body temperature, for the combined action of these agencies is to 
lessen the combustion process. After death from chloral, congestion 
of the meninges of the brain and cord, of the lungs, and distention 
of the right cavities of the heart, have been observed. The arrest 
of the heart's action takes place in the diastole. 

Chloral does not affect the motor nerves nor impair the contrac- 
tility of muscle ; hence the paralytic phenomena both of animal and 
of organic life produced by it are due to its direct action on the 
nervous centers. 

Very large quantities of chloral have been taken without pro- 
ducing fatal symptoms. I have seen a patient who took daily from 
two drachms to three drachms of chloral for many months, without 
any symptoms of acute poisoning. While it is true that enormous 
doses (several hundred grains) have been taken without producing 
lethal effects, it is equally true that serious symptoms and death have 
resulted from very moderate doses (twenty to thirty grains). Great 
care should therefore be taken in prescribing an agent of such uncer- 
tain power. A fatty heart, atheromatous degeneration of the vessels, 
advanced disease of the lungs, and instability of the nervous system, 
are contraindications of the use of chloral. 

Chloeal-Habit. — The habitual use of chloral constitutes a dis- 
order, which, if not as persistent as the opium -habit, has its own 
difficulties and dangers of no little importance. Those who take 
choral habitually have irritable, injected, and rather brilliant eyes, and 
are voluble in speech, and have a rather excited and hurried manner. 
They complain usually of singing in the ears, of an empty or vacuous 
feeling in the brain, and are subject to sudden attacks of vertigo. 
They are wakeful, and very nervous and excitable, without chloral, 
when the time for sleep arrives, and they are usually entirely unable 
to sleep without the usual dose of the hypnotic. During the day they 
are melancholy, easily fatigued, and their voluntary movements are apt 
to be uncertain and disordered. The appetite is always capricious, 
frequently wanting ; digestion is labored ; the secretion of bile is de- 
ficient, the stools being rather white and pasty ; the urine stained with 
the bile-elements, and sometimes albuminous. 

An increasing weakness and irregularity in the action of the heart ; 
dyspnoea, chiefly when the stomach is distended ; redness, injection, 
and ecchymoses of the skin, have been occasionally observed to occur 
in cases of the chloral-habit. 

The best method of managing these unfortunate cases consists in 
the very gradual diminution of the daily quantity of chloral ; in regu- 
lation of the diet and administration of a suitable supply of food ; air, 
exercise, and change of scene ; chalybeate tonics ; hyoscyamus and 
lupuline as calmatives, strychnine and picrotoxin as nerve stimulants ; 
occasional purgatives. 






CHLORAL. 567 

Thekapy. — Chloral is a remedy of great value in sea-sickness. 
From fifteen to thirty grains every four hours, the recumbent posture 
for a short time, and suitable nourishment, are the most effective means 
we now possess for this troublesome disorder. In some cases of sick- 
ness of pregnancy chloral is equally effective, but, like other remedies 
for this condition, it often fails. According to the author's observation, 
it is most effective when there is much dizziness, faintness, and repug- 
nance to food, and but little vomiting. When the odor of chloral 
invites nausea, as is not unfrequently the case, it nray be given advan- 
tageously by enema. And, furthermore, rectal injection of fifteen to 
thirty grains, proj:>erly diluted, is an effective remedy for nausea and 
vomiting of reflex origin, as occur in cases of uterine fibroids, gastro- 
enteritis of children (Kjelberg), etc. 

In severe cases of cholera-morbus, with cramps, coldness of the sur- 
face, cold breath and cold tongue, remarkable relief is procured, and 
the patient not unfrequently wrested from a condition of extreme dan- 
ger, by the hypodermatic injection of chloral. There is no means of 
treatment of cholera now known so effective as this, as the author has 
personally witnessed. The effectiveness of chloral is increased by com- 
bination with morphine. 3 Chloral, hydratis, 3 iij ; morphinse sulph., 
gr. iv ; aquae laur.-cerasi, 5 j. M. Sig. : From fifteen to thirty minims 
— for cholera, cholera-morbus, etc. This injection produces consider- 
able burning pain and an indurated lump, but in the author's expe- 
rience suppuration has not followed. 

As chloral produces a lowering of the temperature, and, according 
to Richardson, diminishes the coagulability of the fibrin, good results 
may be expected from its use in inflammations and fevers. It is es- 
pecially indicated when the temperature is high and there are much 
delirium and restlessness present. The author has observed excellent 
results from its use under these circumstances in the eruptive fevers, 
pnemnonia, etc. It should 'not be forgotten, however, that chloral 
must be prescribed with caution when there is ischsemia of the arterial 
system — a condition which must necessarily exist when a considerable 
portion of the lung-space is blocked up by fibrinous or caseous de- 
posits. In pleuritis, endo- and pericarditis, and in peritonitis, much 
good will result from the use of moderate doses of choral — five grains 
every three hours. It is useful because it allays restlessness, causes 
sleep, lowers the fever, and limits or prevents fibrinous deposits and 
exudations. 

The most important uses of chloral are in diseases of the nervous 
system. As an hypnotic, pure and simple, it is quite unrivaled. Cases 
of sleeplessness, due to mental overwork, anxiety, or physical fatigue, 
are entirely relieved by fifteen to twenty grains of chloral. The re- 
freshing sleep thus obtained not unfrequently leads to repeated and 
long-continued use of chloral, and thus the chloral-habit is formed. It 



56S CEREBRAL SEDATIVES. 

follows that sleep should be procured by proper hygienic methods in 
such cases, if possible, and chloral should be resorted to only after the 
failure of such means. No hypnotic is so uniformly successful in pro- 
curing sleep in delirium tremens; but this remedy, as other remedies of 
the same class, not unfrequently fails. It is more particularly adapted 
to those cases in which the delirium has succeeded to a debauch, and 
is less useful, and may, indeed, produce serious symptoms, in old, worn- 
out drunkards. Violent excitement not unfrequently is produced by 
it when it fails to cause sleep. The author must caution his younger 
readers against the too large administration of chloral in this disease. 
Sleep may be procured which will end in fatal exhaustion. Especially 
should caution be used in the old drunkard, whose heart and vascular 
system may have undergone serious fatty and calcareous degeneration. 
In suitable cases there is no doubt chloral is a remedy of the highest 
value, but it should not be used to the exclusion of suitable hygienic 
and dietetic treatment. 

Various forms of mania, in which delirium and wakefulness are 
prominent symptoms, are largely benefited by hypnotic doses of 
chloral. This remark is true of acute mania, acute melancholia, 
puerperal mania, acute maniacal delirium, and the excitement which 
occurs in general paralysis of the insane. When it agrees, and pro- 
duces refreshing sleep, marked improvement in the mental state not 
unfrequently follows its use. In incurable and intractable cases, 
chloral often renders the greatest service as a calmative and an 
hypnotic. 

Puerperal convulsions, when the patient is in a condition to swal- 
low, may be arrested by full doses of chloral — twenty grains every 
two hours ; also, subcutaneously in five-grain doses, it is highly effec- 
tive, according to Purefoy, and by the rectum its acts admirably in 
many cases. Infantile convulsions, when due to reflex irritation, may 
be suspended by the same means. When the jactitations of chorea 
are so incessant as to prevent sleep, or when they occur during sleep, 
chloral may be administered with advantage. It is not a curative 
agent in chorea, but when it produces quiet and refreshing sleep it 
indirectly contributes to the cure. 

Some of the respiratory neuroses are greatly benefited by chloral. 
The paroxysms of spasmodic asthma may be arrested by it, and the 
spasmodic attacks of difficidt breathing which accompany emphysema 
may be decidedly ameliorated by timely doses of chloral. It must not 
be forgotten, however, that the use of chloral is not unattended with 
danger in pulmonary diseases with ischaemia of the arterial system. 
In the spasmodic stage of whooping-cough, great relief to the parox- 
ysms may be obtained by the use of this agent. From five to ten 
grains will generally be a suitable quantity for administration in these 
cases. Impending attacks of laryngismus stridulus may be prevented, 



CHLORAL. 569 

and seizures already in action can be quickly arrested, by a full dose 
of chloral — five to fifteen grains. 

We have no remedy more effective in tetanus than chloral, but it 
must be given in large doses. Nocturnal attacks of epilepsy may not 
unfrequently be prevented by a full dose of chloral at bedtime. In 
paralysis agitans, good effects have been attained by hypnotic doses 
at bedtime. Chloral is a physiological antagonist to strychnine, and 
may, therefore, be used with advantage in poisoning by this substance. 

Chloral is not unfrequently prescribed to relieve pain, but under a 
mistaken notion of its physiological powers. It can only relieve pain 
by suspending the functions of the cerebrum, and in doses, therefore, 
which are dangerous. It has no direct pain-relieving power, like mor- 
phine. When pain is to be relieved and sleep procured, the combina- 
tion of chloral and morphine is extremely effective. Although chloral 
does not directly suspend the functions of the sensory nerves, it relieves 
certain kinds of pain due to irregular or overaction of unstriped mus- 
cular fibers. Very great relief is afforded by chloral to the irregular 
pains of the first stage of labor, which cause suffering but do not ad- 
vance the case — the so-called "nagging pains," in popular obstetric 
language. Rigidity of the os uteri and soft parts may be corrected 
by the timely administration of chloral, and exhaustion may be pre- 
vented by giving it in such a way as to suspend irregular uterine 
action and to procure sleep. After-pains are stopped by chloral. In 
all these cases of obstetric diseases, large doses are generally required. 

A solution of chloral is an excellent antiseptic application to foul 
wounds: it destroys the odor of putrefaction, arrests fermentative 
changes, and promotes the formation of healthy granulations. It may 
be used to preserve anatomical preparations and morbid specimens. 
A weak solution of chloral (gr. j to grs. iv — • J j) is an excellent in- 
jection in gonorrhoea. 

Equal parts of chloral and camphor, triturated together, form a 
clear fluid, which is often of great service in neuralgia, applied to the 
affected part. It is painted lightly over the surface with a camel's- 
hair brush, and is allowed to dry on. It is said to allay spasmodic 
cough when painted over the larynx. The solution of camphor and 
chloral thus prepared has decided solvent properties. Morphine sul- 
phate will dissolve in it in the proportion of a scruple to two drachms, 
and chloroform can then be added without a separation of the ingre- 
dients. A mixture thus prepared is a very effective local application 
in superficial neuralgias, and as an internal remedy in colic, cholera- 
morbus, cholera, etc. 

Authorities referred to : 

Amory, Dr. Robert. The New York Medical Journal, vol. xv, p. 606. 
Andrews, Dr. J. B. The Physiological Action and Therapeutic Use of Chloral, Utica, 
N. Y., 1871. 



570 CEREBRAL SEDATIVES. 

Browne, Lennox The British Medical Journal, March 7, 1874, p. 304. 
Da Costa, Dr. J. M. Clinical Notes on Chloral. American Journal of Medical Sci- 
ences, April, 1870, p. 359. 

Demarquay, M. JS'otes sur le Chloral. Bulletin de Therapeuiigve, vol. lxxvii, p. 307. 
Husemann, Dr. Theod. Handbuch der gesammten Arzneimittellehre, zweiter Band, 

p. loss. 

Keen, Dr. W. W. The Anatomical, Pathological, and Surgical Uses of Chloral. 
American Journal of Medical Sciences, July, 1875. 

Liebreich, Dr. Oscar. Das Chloralhydrat, ein neues Hypnoticum und Ancestheticum, 
und dessen Anwendung in der Medicin, zweite Auflage, Berlin, 1869. 

Lange, Dr. Ueber die Wirkung des Chloralhydrat. Berliner klinische Wochenschrift, 
Xo. 10, 1870. 

Personne and Bouchut, MM. TJie Medical Times and Gazette, vol. xi, 1869, p. 605. 

Richardson, Dr. B. W. On the Physiological Actions of Chloral. The Medical 
Times and Gazette, vol. xi, 1869. 

Reynolds, Dr. J. Russell. The Practitioner, vol. iv, p. 188, March, 1870. 

Toaiaszewicz, A. Die Wirkuugen des Chloral und der Trichloressigsdure. Archiv 
fur Physiologie, ix, p. 35, Mai, 1874. Schmidts Jahrbucher, Xo. 8, 1874. 

Wells, Mr. Spencer. On Hydrate of Chloral and its Use in Practice. The Medical 
Times and Gazette, vol. xi, 1869. 



Croton-Chloral Hydrate. — This substance occurs in rather small and 
brilliant tabular crystals. It is soluble in water, but not freely so ; 
and, as respects antagonists and incompatibles, may be classed with 
chloral hydrate. Dose, grs. ij — grs. xv, largely diluted in water. It 
may also be conveniently made into pills with glycerite of traga- 
canth. 

Physiological Actions and Thekapt. — Croton-chloral resembles 
chloral in its hypnotic action, but it is feebler and also less certain. 
As in lethal doses it causes death by paralysis of respiration, it is 
admissible in cases of weak heart. It ; differs from chloral, especially 
in the singular property which it possesses of causing anaesthesia of the 
head. Croton-chloral is much less certain in its effects than chloral : 
sometimes one or two grains will relieve severe trigeminal neuralgia ; 
and often from five to fifteen grains are necessary. When pain is to 
be relieved and sleep procured, the best results are obtained by a com- 
bination of the two agents. 

Croton-chloral has proved very effective in various neuralgia. It 
has been especially useful in tic- douloureux, in which it should be given 
in doses of two to five grains every hour or two, until fifteen grains 
have been taken. It is probably not safe to exceed this amount at 
one time. The pains of dysmenorrhcea and sciatica have also been 
relieved by the use of this remedy. 

Authorities referred to : 

The British Medical Journal, October 30, 1873, March 7, 1874. 
Schmidt's Jahrbucher. Papers by Profs. Liebreich, Benson, Baker, and Wickham 
Legg, Band 161, p. 16 



OPIUM. 571 

Opium. — Opium. Opium, Fr. ; Opium, Ger. The concrete milky 
exudation obtained in Asia Minor from the unripe capsules of Papa- 
ver somniferum, by incision and spontaneous evaporation. (Nat. Ord. 
Papaveraeeas). 

Opium should yield at least nine per cent of morphine by the pro- 
cess of assay. 

Opii Pulvis. — Powdered opium. Opium dried at a temperature 
not exceeding 185° Fahr., and reduced to a moderately fine powder 
(No. 50). It should contain not less than twelve nor more than six- 
teen per cent of morphine. Dose, gr. j — gr. iij. 

Opium Denarcotisatum. — Denarcotized opium. Opium freed 
from materials soluble in ether — odorous matters, narcotine, etc. It 
should contain fourteen per cent of morphine. Dose, gr. j — gr. iij. 

JEmplastrum Opii. — Plaster of opium. (Extract of opium, Bur- 
gundy pitch, and lead-plaster.) 

Extr actum Opii. — Extract of 0]3ium. Dose, gr. ss — grs. ij. 

Pilules Opii. — Pills of opium. Dose, one to four pills. Each pill 
contains one grain of opium. 

Pulvis Ipecacuanhas et Opii. — Compound powder of ipecacuanha. 
Dover's powder. Ten grains contain one grain each of ipecac and of 
opium, and eight grains of sugar of milk. 

Tinctura Opii. — Tincture of opium. Laudanum. Thirteen minims 
or twenty-five drops are equivalent to one grain of opium. 

Acetum Opii. — Vinegar of opium. Ten minims or twenty drops 
are about equal to one grain of opium. 

Tinctura Opii Camphorata. — Camphorated tincture of opium. , 
Paregoric. Half a fluid ounce contains nearly one grain of opium. 
Dose, for children, from gtt. v. — gtt. xx ; for adults, from 3 j — 1 j. 

Trochisci Glycyrrhizm et Opii. — Troches of licorice and opium. 
Dose, one to three or four. 

Tinctura Opii Deodorata. — Deodorized tincture of opium. Dose, 
m v— 3 j. 

Vinum Opii. — Wine of opium. (Opium, cinnamon, cloves, sherry 
wine.) Dose, tt], v — 3 j. 

Composition. — About half of the weight of opium is made up 
of gum, pectin, albumen, fragments of the poppy-capsules, and cal- 
careous salts. It contains, also, some coloring-matter, and a volatile 
substance in minute quantity. The proportion of water varies from 
twelve to thirty per cent. A large number of basic, acid, and neutral 
substances have been and are still being discovered in opium, hence its 
chemistry is very complex. 

The following natural alkaloids have been found in opium. Vari- 
ous derivatives of these have also been described. This list, except 
some unimportant modifications, is taken from Fliickiger and Han- 
bury's admirable Pharmacographia : 



572 CEREBRAL SEDATIVES. 

Uydrocotarnine. — Crystallizable, alkaline. Volatile at 100°. (C 

h,.n,o s .) 

Morphine (morphina). — Crystallizable, alkaline. (C^H^NjO,.) 

Pseudo-morphine. — Crystallizes with H 2 0, does not unite even 
with acetic acid. (C n H 19 Nj0 4 .) 

Codeine (codeina). — Crystallizable, alkaline, soluble in water. (C 18 
H.N.O..) 

Tliebaine (thebaina). — Crystallizable, alkaline. (C 19 H 91 N x O,.) 

Protopine. — Crystallizable, alkaline. (C^H^N^O^) 

Laudamine. — An alkaloid, which, as well as its salts, forms large 
crystals. (C„H, 1 N 1 0,.) 

Codamine. — Crystallizable, alkaline ; can be sublimed. (C M H st N, 
0,) 

Papaverine (papaverina). — Crystallizable, alkaline. (C^H^N^.) 

Phceadine. — Crystallizable, not distinctly alkaline ; can be sub- 
limed. (C^H^O..) 

Meconidine. — Amorphous, alkaline ; melts at 58° ; not stable ; the 
salts also easily altered. (C 2 H a3 N 1 4 .) 

Cryptopine (cryptopina). — Crystallizable, alkaline ; salts tend to 
gelatinize ; hydrochlorate crystallizes in tufts. (C 21 H 23 N 1 B .) 

Laudanosine. — Crystallizable, alkaline. (C 21 H 27 N 1 4 .) 

Narcotine (narcotina). — Crystallizable, not alkaline ; salts not sta- 
ble. (CXN.O,.) 

Lanthopine. — Microscopic crystals, not alkaline. (C 23 H 25 K 1 4 .) 

Narceine (narceina). — Crystallizable as a hydrate ; readily soluble 
in boiling water or in alkalies. (C 23 H 29 Ni09.) 

The only important derivative in the therapeutic sense is apomor- 
■phine, obtained from morphine by the action of hydrochloric acid. 
This possesses active emetic property, and will be grouped with 
emetics. 

Besides the foregoing alkaloidal and basic substances, opium con- 
tains a peculiar acid {meconic acid), and, according to T. and H. Smith, 
a peculiar form of lactic acid (thebolactic). 

The proportion of morphine in Turkey opium should not be less 
than ten per cent, and in good specimens may reach fifteen per cent. 
Pseudo-morphine occurs in the minute quantity of 0*02 per cent. The 
proportion of codeine varies from one fifth to two fifths per cent. The- 
baine and papaverine exist in Turkey opium in about the proportion 
of one per cent. Narcotine is found in considerable quantity in differ- 
ent varieties of opium, and ranges in amount from one and five tenths 
to ten per cent. Narceine varies from 0*1 to 0*71. The quantity of 
cryptopine and rhceadine is extremely small. 

The morphine of opium exists in the drug in the form of the tri- 
basic meconate. The proportion of meconic acid is about three to four 
per cent of the crude opium. 



OPIUM. 573 

The value of opium depends on the quantity of morphine which it 
contains. 

Morphina. — Morphine. In colorless crystals, which are inflammable 
and wholly dissipated by red heat. It is scarcely soluble in cold water, 
sligntly so in boiling water, and freely soluble in boiling alcohol. 
Nitric acid first reddens it, and then renders it yellow. With a solu- 
tion of sesquichloride of iron, it assumes a deep-blue color. Its so- 
lution restores the color of litmus, previously reddened by an acid. 
(IT. S. P.) 

3Iorphince Acetas. — Acetate of morphine. A white, yellowish- 
white, crystalline or amorphous powder, slowly losing acetic acid when 
kept for some time and exposed to the air, having a faintly acetous 
odor, a bitter taste, and a neutral or faintly alkaline reaction, When 
freshly prepared, the salt is soluble in twelve parts of water and in 
sixty-eight parts of alcohol ; if it has been kept for some time, it is 
incompletely soluble in water, unless a little acetic acid is added. Dose, 
gr. f-gr. ss. 

Morphince Hydrochloras. — Hydrochlorate of morphine. In snow- 
white, feathery crystals, wholly soluble in water and in alcohol. Dose, 
gr. f-gr. ss. 

Morphince Sulphas. — Sulphate of morphine. In snow-white, feath- 
ery crystals, which are wholly soluble in water. Dose, gr. -jt — gr. ss. 

Pulvis Morphince Compositus. — Compound powder of morphine 
(Tully's powder). (Morphine sulphate, one part ; camphor, twenty 
parts ; glycyrrhiza, twenty parts ; precipitated carbonate of calcium, 
twenty parts ; and sufficient alcohol to make a mixture.) Dose, gr. j 
— gr. x. 

Trochisci Morphince et Ipecacaanhce. — Troches of morphine and 
ipecacuanha. (Morphine, ipecac, sugar, oil of gaultheria, mucilage.) 

Codeina. — Codeine. White, or yellowish- white, more or less trans- 
lucent, rhombic prisms, somewhat efflorescent in warm air, odorless, 
having a slightly bitter taste and an alkaline reaction. Soluble in 
eighty parts of water at 60° Fahr. and in seventeen parts of boiling 
water ; very soluble in alcohol and in chloroform ; also, soluble in six 
parts of ether. Dose, gr. ss — gr. ij. 

Various salts of codeine are now prepared, but the sulphate is the 
most important and desirable. 

The other alkaloids of opium are not official. 

JVarcotince Hydrochloras. — Hydrochlorate of narcotine (not offi- 
cial). Dose, gr. ij — gr. x, as an antiperiodic. 

Antagonists and Lstcompatibles. — As regards chemical antago- 
nism, the alkaline carbonates, lime-water, and the salts of iron, lead, 
copper, zinc, mercury, and Fowler's solution, are incompatible with 
the preparations of opium. Notwithstanding this chemical incom- 



574 CEREBRAL SEDATIVES. 

patibility, the metallic salts are frequently given in conjunction with 
opium, and the systemic effects of both are produced. Astringent 
vegetables (tannin) are also incompatible ; they limit physiological 
activity by forming tannate of morphine, which is not readily soluble. 

In cases of opium-poisoning, if any portion of the drug remain mi- 
absorbed in the stomach, the most prompt and efficient emetic should 
be used. Apomorphine should be injected subcutaneously, if the patient 
is unable to swallow ; if conscious, the sulphate of copper may be ad- 
ministered by the stomach. In a case of opium narcosis which re- 
sisted ordinary emetics, violent emesis was induced by a solution of 
bicarbonate of sodium, followed by a solution of tartaric acid. In the 
absence of other and more active emetics, powdered mustard may be 
administered — a tablespoonf ul to a teacupful of warm water. When 
the opium swallowed is in solution, the stomach-pump should be used 
if the narcosis is profound. Cold affusion, artificial respiration, when 
the breathing flags, and faradization of the chest-muscles, are measures 
of great practical utility. The author has personally witnessed in 
several cases the excellent effects of faradization, first, in causing such 
irritation of the surface as to produce reflex excitation of the respi- 
ratory center ; and, second, inducing contractions of the respiratory 
muscles. As a peripheral irritant, faradization is more humane and 
seemly, and also more efficient, than flagellation. 

The action of opium is antagonized, at least in a part of the sphere 
of its influence, by belladonna. These agents are opposed as regards 
their influence on the intra-cranial circulation, on the pupil, on the re- 
spiratory organs, and on the heart. Opium in lethal doses causes paresis 
of the arterioles and veins ; belladonna contracts them, and, by energiz- 
ing the cardiac movements, substitutes an active for a passive conges- 
tion. It can not be too strongly insisted on in this connection that bella- 
donna in too great quantity, or too long in action, exhausts the irritabil- 
ity of the unstriped muscular fiber, and thus induces the very state which 
its administration leas intended to relieve. The state of the pupil, the 
action of the heart, and the condition of the reflex movements, are the 
guides to the administration of belladonna in cases of opium narcosis. 
The smallest quantity of belladonna which will dilate the pupil, raise 
the tension of the arterial system, deepen the respiration, and re-estab- 
lish the reflex excitability, should be used. The author has a strong 
conviction, arising from some painful personal experience, that it is a 
fatal error to attempt to restore a patient in opium narcosis to com- 
plete consciousness by repeated doses of belladonna. The action of 
these agents combined is to produce profound sopor, and this is not a 
condition of danger so long as the pulse, respiration, and reflex move- 
ments are in good condition. To substitute belladonna narcosis for 
opium narcosis is only increasing the hazard under which the patient is 
already struggling. Impatient to afford relief, and assuming that the 



OPIUM. 575 

tendency to sleep must be obviated, the physician too frequently, as the 
history of many cases plainly shows, repeats the doses of belladonna 
until its action greatly preponderates, and the irritability of the cardiac 
ganglia is completely exhausted. The author, therefore, feels himself 
warranted in repeating that the utility of belladonna consists in its 
power to maintain the action of the heart, and the respiration, until 
elimination has taken place, and that even coma is of little importance 
provided the respiration, circulation, and reflex movements are prop- 
erly maintained. 

The hypodermatic injection of atropine is the most efficient and 
satisfactory method of employing this physiological antagonist. Not 
more than y^- of a grain of the sulphate should be administered at a 
dose, and this may be repeated every fifteen minutes (up to three 
doses) until dilatation of the pupil, increased power of the cardiac move- 
ments, deeper respiration, warmth and dryness of the skin, and flush- 
ing of the face, are produced. No more can be accomplished by the 
largest doses, and the results of the antagonism must be awaited. 
Belladonna continues longer in action than opium. In a succeeding 
chapter, devoted to the consideration of the combined administration 
of opium and belladonna, or morphine and atropine, the nature and 
degree of the antagonism will be more fully elaborated. 

Coffee is also an antagonist to opium, especially caffeine subcuta- 
neously, in doses of three to five grains, repeated as may be required, 
up to twenty grains. Good results have undoubtedly been obtained 
by the free use of black coffee, in milder cases of opium narcosis. 
The unpleasant confusion of mind, and vertigo, which in so many 
subjects are experienced after the subsidence of the effects of a me- 
dicinal dose, may sometimes be removed by a cup of strong coffee. 
These cerebral effects may be prevented, or relieved when they occur, 
by a full dose of bromide of potassium. This discovery, if we may 
dignify so small a matter by so imposing a title, was briefly an- 
nounced by the author in the first edition of his work on " Hypoder- 
matic Medication." 

Gubler has shown that some of the cerebral effects of opium are 
antagonized by quinine. Tartar emetic and digitalis also oppose to 
some extent the action of this remedy on the intra-cranial circulation. 

Synergists. — The cerebral and hypnotic effects of opium are pro- 
moted by alcohol and its derivatives (notably chloral), and, within 
certain limits, by the mydriatics. The sudorific action of opium is in- 
creased by ipecacuanha. 

Physiological Actions. — As opium is a very complex substance, 
made up of numerous principles which differ remarkably among them- 
selves, it will conduce to a better understanding of its actions to con- 
sider, first, opium as a whole, and then follow with some details re- 
garding its individual constituents. 



576 CEREBRAL SEDATIVES. 

The physiological effects of opium are best studied as respects — 1, 
small medicinal doses ; 2, full medicinal doses; 3, lethal doses. 

1. The preparations of opium have a disagreeable, bitter, and rather 
nauseous taste. Dryness of the mouth and fauces, huskiness of voice, 
and diminution in the sense of taste, occur in a short time after admin- 
istration of the drug has begun, and continue during the whole period 
of its influence. To the dryness succeeds a viscid secretion, which 
contains excrementitious matter having a foul odor. When opium 
does not produce nausea, the appetite may not be impaired, may be 
even increased ; but the rule is that the desire for food is lessened by 
opium. The secretion of mucus, and of the special glandular appara- 
tus of the gastro-intestinal mucous membrane, is lessened by opium, 
and hence the digestion and the peristaltic movements are less active. 
The excretions being thus locked up, dullness and hebetude are expe- 
rienced, the skin looks muddy, the tongue is coated, and the breath is 
offensive. When the influence of the opium ceases, it not unfrequent- 
ly happens that the constipation is succeeded by relaxation of the in- 
testines, and rather profuse and fetid evacuations, and increased urin- 
ary discharges, take place. 

The action of the heart becomes stronger, and the arterial tension 
rises. When opium agrees, the sense of fatigue vanishes, and muscu- 
lar movements become more rapid and easy. The face flushes a little, 
the pupil contracts slightly, the conjunctivae may be somewhat in- 
jected, and the expression of the eye more brilliant. At this stage the 
ideas flow more rapidly, but are less sustained and orderly. The ap- 
preciation of time, the sequence of events, and the sense of moral fit- 
ness, are diminished. The cerebral excitement is, after a period which 
varies in different individuals, succeeded by calm, by drowsiness, and 
sleep when it occurs is usually disturbed by visions and dreams, often 
of a frightful character. In most subjects, after the sopor has passed 
off, headache, vertigo, confusion of mind, nausea, constipation, and 
muscular hebetude, are experienced. 

2. When full medicinal doses are administered, the symptoms 
above described occur in a more intense degree. The stage of cardiac 
stimulation and of cerebral excitement is of much shorter duration ; 
and the stage of intoxication and sopor not only comes on more quick- 
ly, but is much more pronounced. At first the pulse is increased in 
frequency and the respiratory movements are more rapid ; but the car- 
diac pulsations soon diminish in number and force, and the respira- 
tions become sighing in character and more shallow. There is also 
present decided dryness of the mouth, fauces, and larynx, and swallow- 
ing becomes somewhat difficult and the voice grows husky. Nausea 
and vomiting, or at least weight and oppression of the epigastrium, 
ensue. Confusion of ideas, vertigo, somnolence, are succeeded by 
deep sleep, contracted pupils, slow and relaxed pulse, slow and snoring 



OPIUM. 577 

respirations, a perspiring skin, and, in many persons, an intense gen- 
eral pruritus, which, however, is more harassing at the nasal orifices. 

Persons not habituated to the use of opium usually experience, after 
a full medicinal dose has expended its force, very distressing sequelae, 
referable to the cerebro-spinal system. The most important of these 
after-effects are headache, confusion of mind, vertigo — which is espe- 
cially severe on assuming the erect posture — nausea, retching and vom- 
iting, complete anorexia, and constipation. A mild but defined hepa- 
togenic jaundice not unfrequently occurs, and the urine is tinged with 
the coloring-matter of the bile. 

3. A lethal dose of opium causes but a transient excitement ; the 
stage of narcosis quickly supervenes, and the functions of animal life 
are often rather abruptly suspended. The patient soon lapses into a 
condition of insensibility, with a slow and feeble, or, it may be, rapid 
and feeble, action of the heart ; slow respiration, shallow and quiet or 
stertorous ; face at first flushed, but soon becoming shrunken, pallid, 
and cyanosed ; skin wet ; pupils minutely contracted and insensible to 
stimulation ; unconsciousness profound, with muscular relaxation and 
abolition of reflex movements. This state of opium narcosis is with dif- 
ficulty distinguished from alcohol narcosis, from cerebral haemorrhage 
— especially in the pons — and from uraemic coma. An attentive con- 
sideration must be given to all available facts in the history of the 
case, to the surroundings of the patient, and to the odor of the breath 
or other excretions, for the symptoms of one of the states above men- 
tioned may be represented in another, even to the inequality of the 
pupils, since a case of opium narcosis has been reported in which such 
inequality existed. 

There are no characteristic structural alterations produced by opi- 
um. The brain presents the appearance known as the " wet brain " 
by pathologists ; the subarachnoid spaces and the ventricles contain an 
abnormal quantity of serum ; the intra-cranial veins are engorged, and 
the puncta vasculosa are somewhat more numerous. The right cavi- 
ties of the heart and the large venous trunks are usually distended 
with soft coagula. These appearances are largely due to the mode 
of dying. In consequence of the diminishing frequency of the respir- 
atory movements, the blood is imperfectly decarbonized, and the capil- 
lary circulation of the lungs is impeded. The action of the heart 
being weak and the resistance a fronts increased, it is obvious that 
venous stasis must take place. 

It is necessary now to consider somewhat more minutely the na- 
ture and degree of the action of opium on the different organs and 
systems of the body. It will save space and avoid repetitions to 
study these actions in connection with the several principles contained 
in opium. 

The Physiological Action of the Alkaloids of Opium. — 1. 
3S 



578 CEREBRAL SEDATIVES. 

Morphine. — The peculiar powers of opium are represented chiefly in 
the morphine which it contains. In opium of good quality the pro- 
portion of morphine is from ten to fifteen per cent. The actions of 
the other principles contained in opium differ widely ; and as they all 
possess some activity, the sum of their effects must so far influence the 
result that the powers of opium and morphine must vary somewhat in 
kind as well as in degree. One sixth of a grain of morphine is about 
equivalent in activity to one grain of average opium. 

In general terms, it may be stated that morphine differs from opi- 
um in the following respects : 

Morphine is less stimulating, less convulsant, and more decidedly 
hypnotic and anodyne than opium. 

Morphine constipates less and affects the contractility of the blad- 
der more than opium. 

Morphine has less diaphoretic action and produces much more pru- 
ritus than opium. 

The physiological action of morphine is best studied as adminis- 
tered subcutaneously. In a short period — from a few seconds to a few 
minutes — after the insertion of an ordinary dose — one sixth to one 
fourth of a grain — under the skin, the symptoms of morphine narco- 
sis begin. A sense of heat and flushing of the face — after, in most 
subjects, a very transient pallor — fullness of the head, giddiness, tin- 
nitus aurium, and frequently nausea, are experienced. Deep-seated 
epigastric pain is often felt, and loud borborygmi occur. The verti- 
go may be so considerable as to render walking uncertain and stag- 
gering, or to render the upright position impossible. Injection of 
the conjunctivae and contraction of the pupils occur at the same time 
the cerebral effects are experienced. The lips have a bluish appearance, 
the mouth and tongue become dry, swallowing is painful, and the 
voice has a husky tone. When these physiological effects are produced, 
pain and spasm are relieved, and an indescribable feeling of content 
takes possession of the mind. A condition of somnolence in many 
persons, in others of extreme wakefulness, with intense mental activity, 
is experienced. When sleep occurs, it is usually deep but not calm, 
the respirations are slow, noisy, and labored. Not unfrequently the 
sleep is disturbed by dreams and visions, or the individual passes into 
a somnambulistic state, from which he is aroused with difficulty. The 
action of the heart is diminished in frequency, but a decided rise 
takes place in the arterial tension. On ophthalmoscopic examination, 
a marked increase in the vascularity of the retina, and blurring of the 
papillae, can be discerned. 

Soon after a hypodermatic injection has been practiced, itching of 
the nose, and often of the whole cutaneous surface, is experienced. 
The skin is at first dry, but, after a time, diaphoresis begins and is 
sometimes profuse. The relaxation of the skin is coincident with a 



OPIUM. 579 

fall in the arterial tension. The secretions of the mucous surfaces are 
at first arrested, as well as those of the skin. If the morphine be ad- 
ministered after a full meal, digestion is suspended for a time. The 
intestinal movements are also arrested for a short period, and consti- 
pation is therefore produced. ; but, very frequently indeed, no change 
takes place in the time in which the alvine discharges occur, or in their 
number. Partly in consequence of the increased action of the skin, 
the quantity of urine discharged is lessened, and, at the same time, 
difficulty is encountered in its emission. When the desire is felt, an 
interval of less or greater duration elapses before the flow begins, and, 
as the contractile power of the bladder and of the ejaculatory mus- 
cles is diminished, the discharge is feeble and slow, and the last drops 
linger in the urethra. 

With the decline of morphine narcosis a majority of subjects, prob- 
ably, experience headache, confusion of mind, anorexia, and nausea. 

When a lethal dose of morphine has been administered by any 
mode, profound narcotism quickly ensues ; the pulse becomes slow and 
feeble, or rapid and feeble ; the respirations also become very slow 
and shallow ; the skin cold and sweating ; the face pale, cyanosed, and 
ghastly ; the conjunctivae deeply injected ; the pupils minutely con- 
tracted, and reflex movements entirely abolished. Respiration ceases 
before the action of the heart, as a rule, but in some instances very 
sudden death ensues from paralysis of the heart. 

Half a grain is the smallest dose of morphine which has proved 
fatal to an adult. Five cases, according to Taylor, have been recorded 
in which one grain of the muriate caused death. 

A consideration of the symptoms produced in man by morphine, 
and the results of experiments on animals, prove that it chiefly affects 
the cerebro-spinal functions. In the lower animals, the spinal more ; 
in man, the cerebral more than the spinal functions. Morphine first 
raises and afterward lessens the action of the heart and arteries ; first 
stimulates the pneumogastric end-organs and cardiac motor ganglia, 
and afterward paralyzes both. It causes death chiefly through paral- 
ysis of the muscles of respiration. 

2. Codeine. — According to the author's observations, the codeine of 
commerce corresponds closely in action to morphine, but is much fee- 
bler. Four grains of codeine are about equivalent to one grain of 
morphine. It has anodyne and hypnotic qualities. Codeine produces 
sleep freer from disturbance, and the after-effects are less disagreeable, 
than those of morphine. The special direction to the pneumogastric 
nerve ascribed to it by some observers, seems to the author to exist in 
nature. 

3. JVareotine. — This alkaloid is singularly inappropriately named. 
It has but feeble narcotic power. In children considerable doses pro- 
duce a calmative effect and drowsiness, but these results are not ob- 



580 CEREBRAL SEDATIVES. 

served in adults. Experiments on animals have shown that narcotine 
is a convulsant. While pigeons are poisoned only by two or three 
grains of morphine, administered subcutaneously, the same quantity 
of narcotine causes fatal convulsions. The reverse is true in man. 
Narcotine is allied in action to berberine, and alkaloids of that group, 
so far as the effects on man are concerned ; and to thebaine, picro- 
toxin, strychnine, and brucine, so far as the effects on animals are 
concerned. 

4. Narceine. — The most contradictory observations have been pub- 
lished on the action of this principle. By Bernard, Behier, and Eu- 
lenburg, it is held to possess remarkable hypnotic power, and to be 
free from stimulating and convulsant action ; by Fronmiiller, Harley, 
Da Costa, Mitchell, and others, it is considered feeble, if not inert. 
The physiological actions of narceine, therefore, remain sub judice. 
Until further researches are made with chemically pure narceine, and 
by competent observers, it will be safer to give no opinion on the s ab- 
ject of its actions and uses. 

The other alkaloids of opium are curiosities of chemical and physi- 
ological research, and may be dismissed in a few words. 

Cryptopine is in a much greater degree than narceine an hypnotic 
and anodyne. 

Thebaine has a strong convulsant action in animals. 

Various circumstances modify the action of opium. These are 
chiefly age, sex, idiosyncrasy, habitual use, and certain states of the 
system, as the presence of pain, uraemia, etc. 

The extremes of life are relatively more susceptible to the action 
of opium, and especially is the susceptibility to its action great in 
early life. Fatal opium narcosis has ensued in a nursing infant whose 
mother had taken a medicinal dose. A single drop of laudanum has 
produced lethal effects in a child under six months of age. Women 
are more easily affected by opium than men, and they are more apt to 
be thrown into a condition of hysterical excitement than put to sleep. 
Nausea, vomiting, headache, and depression, much more frequently 
occur in women than in men. As a rule, therefore — but to this rule 
there are, of course, numerous exceptions — women are less favorable 
subjects for the administration of opium than men. 

More than age or sex is the action of opium influenced by idiosyn- 
crasy. There are persons so easily affected by it that the minutest 
quantity will cause uncontrollable vomiting, faintness, vertigo, and 
alarming prostration. It is never safe to administer morphine hypo- 
dermatically to such subjects, unless in an extremely small dose. 

The habitual use of opium diminishes in a remarkable degree the 
susceptibility to its action. Numerous instances are on record in which 
a pint or more of laudanum has been taken daily, or several hundred 



OPIUM. 581 

grains of opium, or a scruple of morphine. The author has met with 
a patient who took a scruple of morphine a day subcutaneously. When 
opium is given by the stomach, for the relief of a chronic painful 
disease, to maintain a constant effect increasing doses are necessary. 
The power of the stomach to absorb opium is doubtless impaired by 
frequent repetition of the dose, and in consequence of the local action 
of the drug on the nerves of the stomach. Besides this, the suscep- 
tibility of the cerebro-sjrinal system steadily declines. The proof of 
these statements is afforded by the action of morphine when used sub- 
cutaneously for long periods. A gradual increase of the dose becomes 
necessary in order to produce a given physiological effect ; but the in- 
crease is much slower than when it is administered by the stomach. 

Great pain lessens the influence of opium upon the centers of con- 
scious impressions. The quantity in grains is of much less importance 
than the quantity as measured by the physiological reactions. Uraemia, 
or the retention in the blood of urinary excrementitious matters, is 
supposed to increase the narcotic influence of opium ; but some facts, 
to be hereafter presented, render it probable that the state of uraemia 
and the influence of opium on the brain are antagonistic. 

Theeapt. — Stomach-pain, whether simply neuralgic (gastralgia), 
or excited by the presence of food {irritative dyspepsia), or due to 
ulcer or cancer, is relieved by opium. The preparations of morphine 
are better than the crude drug, as a rule, in these cases. The endermic 
application is an excellent mode of procuring relief. The subcutane- 
ous injection, practiced in the epigastric region, is still more effective. 
Morphine is frequently combined with bismuth, or zinc, or silver salts, 
in painful stomach diseases. I£ Bismuthi subcarb., vel subnitrat., 
3 iij ; morphinae sulph., gr. j — grs. ij ; pulv. aromat., 3 j. M., ft. pulv. 
no. xij. Sig. : A poicder in milk before each meal. The following 
formula is also useful, notwithstanding its unchemical relations : 3 
Zinci oxidi, 3 ss ; morphinae sulph., gr. j — grs. ij. M., ft. pil. no. x. 
Sig. : One pill, three times a day, before each meal. A half-grain of 
the oxide of silver may be substituted for the oxide of zinc in the 
above formula. 

Inflammatory pain, due to corrosive poisons, to peritonitis, etc., 
requires opium. When the stomach is irritable, and the symptoms 
urgent, the best mode of using the remedy is the hypodermatic injec- 
tion of morphine. Many kinds of nausea and vomiting, stomachal or 
reflex in origin, are arrested by opium preparations. In vomiting of 
cerebral origin, or produced by uraemia, or caused by cirrhosis, the 
use of opium is contraindicated. When vomiting is caused by irritant 
matters, opium is prescribed after the stomach is emptied. The vomit- 
ing which accompanies the passage of biliary or renal calculi, dys- 
menorrhoea, etc., is best relieved by opium. Very severe cases of 
sea-sickness, and of the vomiting of pregnancy, may be sometimes 



582 CEREBRAL SEDATIVES. 

arrested when all other means fail, by the subcutaneous use of a mi- 
nute quantity of morphine (one twentieth to one twelfth of a grain) . 

Nothing is more common than the prescription of opium in diar- 
rheal diseases, but it is often used without a just appreciation of the 
conditions requiring it. In acute diarrhoea, caused by irritating ali- 
ments, such astringent laxatives as rhubarb, or mild salines, should 
precede the use of opium. When the evacuations are watery, the 
best results are obtained by a combination of opium with mineral 
acids, or acetate of lead. In acute dysentery opium is a very im- 
portant remedy, but it is often injudiciously employed. If there be 
fever, much tenesmus, and the stools consist of mucus and blood, the 
exhibition of opium should be postponed until salines have emptied 
the intestinal canal of its contents, and have depleted the distended 
vessels. An excellent method of administration, especially when the 
dysenteiic inflammation occupies the rectum, is an enema of starch or 
milk, or a suppository, containing opium in some soluble form. In 
chronic dysentery opium is indispensable. It is usually combined 
with arsenic, or with the salts of silver, copper, or zinc. In the 
chronic dysentery of malarial origin, the best results are obtained by 
a combination of arsenic and opium, according to a formula already 
given ; in that form which succeeds to the acute disease, opium and 
sulphate of copper, or zinc, or nitrate of silver, or vegetable astrin- 
gents. 

Nothing can be more satisfactory than the treatment of cholera- 
morbus by the hypodermatic injection of morphine. It is always 
desirable to secure the expulsion of irritating matters before resorting 
to opiates. For an ordinary case of cholera-morbus from one twelfth 
to one sixth of a grain of morphine suffices. In true cholera the 
utility of opium is most evident in the preliminary diarrhoea, but is 
entirely without avail in the stage of collapse. Mischief not unfre- 
quently results from its use, for patients emerging from the condition 
of collapse are either directly narcotized by the opium which had lain 
unabsorbed in the stomach, or the cerebral symptoms of the secondary 
fever are greatly intensified by it. In cholera infantum opium must 
be used with caution, if not avoided. The subjects of this malady 
are easily narcotized, and the nervous system — an unknown morbid 
state of which bears some close relation to the gastro-intestinal dis- 
order — is rendered so irritable by opium that the symptoms are ag- 
gravated by it. 

The following formula embodies a truth of great practical impor- 
tance : As a rule, opium does harm in all gastro-intestinal maladies 
in which there is a deficiency in the proper secretion, or a suspoision 
of the functions, of the liver and kidneys. 

Opium gives a degree and kind of relief in hepatic, renal, and 
saturnine colic, which no other remedy or combination of remedies 



OPIUM. . 583 

affords. The most prompt and effective form in which the remedy 
can be administered is the hypodermatic injection of morphine. This 
relieves the pain, and relaxes the spasm of the affected tube, and at 
the same time checks the depressing vomiting which attends these 
cases. The quantity of morphine required will vary from one fourth 
to one half a grain. As the effect is immediate, the most prudent 
practice consists in the administration of a small quantity (one sixth 
to one eighth of a grain) for the first dose, in order to test the physi- 
ological capabilities of the patient, and following this in fifteen min- 
utes with a dose of similar size if the first is well borne and the pain 
persist. 

Opium, in small doses, is a valuable tonic to a weak and dilated 
heart. When administered simultaneously with digitalis, it obviates 
one of the dangers which may be caused by that agent. In the so- 
called passive hemorrhages ', in which not only is the blood altered in 
quality but the tension is low, small doses of opium sustain the powers 
of life, and by increasing the arterial tension lessen the transudation 
through the vessel-walls. Under these circumstances, the dose of 
opium should not as a rule exceed five minims of the tinctures, and it 
should generally be given in combination with ergot, digitalis, tannic 
and gallic acids, acetate of lead, etc. 

The important observation was made by Bernard, and afterward 
illustrated and confirmed by Nussbaum, that the hypodermatic injec- 
tion of morphine, administered before the inhalation begins, prolongs 
the stage of chloroform narcosis with a less quantity of the anaesthetic, 
diminishes the danger of cardiac paralysis, and prevents the after-nau- 
sea and depression. 

Opium is the most important agent which we possess in the treat- 
ment of various inflammations. Its efficacy depends upon several fac- 
tors : it relieves pain, quiets restlessness, and thus removes from the 
inflammatory process one of its most important elements, viz., an irri- 
table and paretic state of the nerves of the affected part. Besides 
these effects, opium raises the tonicity of the vessels, helps to maintain 
the continuity of the blood-current, and hinders the migration of the 
white corpuscles of the blood. It is especially in inflammations of the 
serous membranes that its highest utility is manifest, e. g., pleuritis, 
peritonitis, arachnitis. Good reasons exist for believing that the hy- 
podermatic injection of morphine will sometimes cut short (jugulate) 
these maladies, if administered just at their onset. If the period for 
obtaining such a fortunate result has passed, the course and duration 
of these diseases can be greatly modified by the judicious use of opium. 
The quantity of opium required will be determined by the effect ; the 
pain should be relieved, the pupils somewhat contracted. A full dose 
should be administered at the beginning of treatment (two to three 
grains of opium — a half grain of morphine), and a given physiological 



584 CEREBRAL SEDATIVES. 

effect be maintained by the regular use of smaller doses. Pain is 
probably the surest guide, for the existence of pain indicates that de- 
cided opium narcosis has not been attained. 

In peritonitis, whether puerperal, traumatic, or the extension of 
intestinal inflammation, no fact of therapeutics is better established 
than the curative power of opium. Besides its immediate influence 
over the inflammatory process, its indirect action, in maintaining the 
necessary quietude of the intestines, is of the greatest service. In 
arachnitis, pachymeningitis, basilar meningitis, there are clinical facts 
which tend to show that small doses of some opiate preparation really 
accomplish more than any other remedies. The author is convinced 
that we possess no means of treatment of cerebrospinal meningitis so 
effective as the opiate treatment. The same rule as to the quantity 
required, as that given for peritonitis, should be observed : that quan- 
tity of opium should be administered which will relieve the pains and 
rigidity. The best results are obtained by the hypodermatic injection 
of morphine. When effusion takes place, and stupor and coma ensue, 
the utility of opium is ended. 

In parenchymatous inflammations, experience has shown, opium is 
much less useful. When pain is a prominent symptom, it can be em- 
ployed to relieve it ; in small, stimulant doses, it may be given to 
maintain the action of the heart. In pneumonia opium is a remedy of 
very doubtful utility. Its narcotic action certainly disposes to pul- 
monary congestion, although it may be cautiously used to allay pain and 
moderate cough. Although this was the general professional opinion, 
and is now largely held, there are those who entertain very different 
views regarding the utility of opium in pneumonia. Thus, Prof. A. L. 
Loomis, of New York, maintains that the disease may be aborted, or 
at least decidedly modified in severity, by the subcutaneous injection 
of morphine in the first stage (congestion) of this disease. 

Li fevers — typhoid, typhus, and eruptive fevers — opium was for- 
merly much more frequently prescribed than at present. The cold 
baths, antipyretics, and more favorable hygienic influences, have less- 
ened the violence and diminished the mortality from fevers. The 
maniacal excitement and the low, muttering delirium are not so fre- 
quently observed now as formerly, and hence the use of opium in these 
affections has greatly declined. The discovery of chloral has also di- 
minished the use of opium as an hypnotic. Nevertheless, when there 
is much restlessness, Avakefulness, subsultus, and delirium, opium may 
render important service. When the delirium is of the low, mutter- 
ing kind, a small quantity of morphine (one eighth to one sixth of a 
grain) may suffice to procure quiet and refreshing sleep. When the 
delirium is violent, combination of tartar-emetic with opium, on the 
plan of Graves, may have a very happy effect. Or opium may be 
combined with belladonna, or chloral — the former when the condition 



OPIUM. 585 

is one of great depression, the latter when the delirium and wakeful- 
ness are excited in character. In measles and scarlet fever, when there 
is a condition of profound depression, the eruption being tardy in 
making its appearance, and is dusky in hue and ill-defined, beneficial 
results are experienced from the use of opium, especially when com- 
bined with camphor. 

A threatened paroxysm of intermittent fever may be aborted by 
the hypodermatic injection of morphine (one fourth of a grain). This 
practice has a high degree of importance in the pernicious intermit- 
te?its, when time is not afforded for an effective use of quinine. The fe- 
brile heat of intermittent and remittent fevers may be diminished, and 
the sweating stage induced earlier, by the use of opium in moderate 
doses (ten minims of the deodorized tincture every two, three, or four 
hours). The addition of morphine to quinine enables the latter to be 
better borne by the stomach, counteracts some of its unpleasant effects 
on the brain, and increases its therapeutical power. When no contra- 
indication to the use of morphine exists, it is good practice to combine 
it with quinine in the treatment of intermittent and remittent fevers. 

N arcotine has decided antiperiodic power, and may be given as a 
substitute for quinine when reasons exist to prevent the use of the lat- 
ter. From five to ten grains of pure narcotine may be administered. 
As an antiperiodic it ranks after arsenic, salicine, and even apiol. 

As an hypnotic opium is very frequently used in affections of the 
nervous system. The stimulant properties of crude opium, or its offi- 
cial preparations, render it less serviceable than morphine in the 
group of cases generally requiring an hypnotic. There can be no 
doubt that remarkable curative results have followed the hypodermatic 
injection of morphine in acute mania. The following are the indica- 
tions for the use of morphine in mental disorders : prolonged wakeful- 
ness, maniacal excitement, persistent refusal of food, drink, or medi- 
cine, destructive and suicidal tendencies. As respects individual 
subjects, the state of the arterial tension furnishes a guide to the use 
of morphine. If the tension of the arterial system is low, a small dose 
is required. When the pulse is quick, and the arterial tension high, a 
large dose of morphine, by over-excitation, causes paresis of the sym- 
pathetic, and thus reduces action, an indication for the full influence 
of the agent. Large doses of morphine, when given subcutaneously, 
require the utmost circumspection in maniacal cases, especially in 
obese and aged subjects. Besides acute mania, excellent results have 
followed from the use of morphine in lypemania (Krafft-Ebing, Voi- 
sin), in chronic mania, and melancholia. Probably the best effects 
have been witnessed from opium in melancholia. In this mental dis- 
order, which is a condition of depression, the best form for the admin- 
istration of opium is the tincture, and the dose required is the stimu- 
lant and not the narcotic dose. The author is impelled to add the 



5S6 CEREBRAL SEDATIVES. 

caution so well expressed in the following words by Maudsley : "It 
will be well to have in mind that neither opium by the mouth, nor 
morphine hypodermically injected, will always quench the fury of 
acute mania, and that successive injections of morphine, followed by 
brief snatches of fitful sleep, have been followed also by fatal collapse." 

It was formerly held that large and increasing doses of opium were 
necessary for the cure of delirium tremens, the theory being enter- 
tained that to procure sleep was to insure recovery. It is now known 
that to re-establish digestion and to support the powers of life by suit- 
able nutrients are in a large proportion of cases the only means needed 
to quiet delirium and to cause sleep. Opium, if used at all, must be 
given cautiously. Chloral has to a large extent taken its place as an 
hypnotic in this disease, but cases are not unfrequently met with 
in which morphine agrees better, and is more effective in inducing 
quiet. 

Some cases of sunstroke, coup de soleil, or "thermic fever," are 
rapidly cured by the hypodermatic injection of morphine. When the 
patient is able to swallow, good effects follow the conjoined admin- 
istration of tincture of opium and brandy. The cases benefited by 
this treatment are characterized by pallor of the face and weakness of 
the heart — heat exhaustion. 

Epilepsy and epileptiform seizures may be sometimes prevented by 
the timely administration of morphine hypodermatically. This treat- 
ment is best adapted to epilepsy, the attacks of which occur at night, 
to petit mal, and to convulsive tic. It is improper in epileptoid seiz- 
ures due to tumor or other coarse organic lesion of the brain. In 
suitable cases, this treatment procures most decided amelioration in 
the condition of the patient, but may induce the opium habit. 

The remarkable fact has been demonstrated by Loomis, of New 
York, that we have in the hypodermatic injection of morphine the 
most important agent for the cure of urcemic convulsions, puerperal 
and non-puerperal. It is true this mode of treatment had been origi- 
nally practiced by Scanzoni, but Loomis has, more especially, drawn 
attention to its real power and utility. " The most uniform effect of 
morphine so administered is, first, to arrest muscular spasms by coun- 
teracting the effect of the uraemic poison on the nerve-centers ; second, 
to establish profuse diaphoresis ; third, to facilitate the action of ca- 
thartics and diuretics, especially the diuretic action of digitalis." 

In chorea Trousseau has carried the administration of morphine to 
an extraordinary extent. He restricts its use to severe cases, which 
appear to have a singular insusceptibility to the action of opium even 
in enormous doses. When the jactitations are incessant, preventing 
sleep, or persisting in spite of sleep, the utility of morphine is very 
great. It is most effective when combined with chloral. In these se- 
vere cases of chorea, the only limit to the quantity of morphine is the 



OPIUM. 587 

effect produced. It is evident, from the experiences of Trousseau, 
that very large doses are required, and that curative effects are thus 
obtained to which small doses are entirely inadequate. The subcu- 
taneous method is more efficient than the stomach administration. 

In tetanus and hydrophobia the use of morphine has been chiefly 
palliative. M. Demarquay has, however, applied morphine, by deep 
injection into the tetanized muscles, with greater success than hereto- 
fore. He carries the needle deeply into the tetanized muscles, and, if 
possible, to the point of entrance of the nerves. He injects in this 
way the masseters, the sterno-cleido -mastoid, the neck and sacro-lum- 
bar muscles, etc. The relaxation of the muscles of mastication thus 
induced permitted the nourishment of the patients. Of three cases 
thus treated during the siege of Paris two recovered and one died, but 
the death was due to pyaemia and not to tetanus. 

The most important uses of opium and its various preparations are 
in the relief of pain. In surgical practice its administration is indis- 
pensable to prevent or mitigate shock, to quiet pain, and to check in- 
flammation. To particularize on these points would require an epit- 
ome of surgery for illustration. Before the administration of chloro- 
form, morphine should be injected hypodermatically, to diminish the 
dangers of the inhalation and to secure relief to the after-pain of the 
surgical operation. Nothing is more universal in surgical practice 
than the administration of an opiate after an operation of any magni- 
tude, for the objects above named. 

The most signal service is rendered by opium and its preparations 
in the various neuralgias. The most effective mode of administration 
is by subcutaneous injection, and the remedy should be inserted in the 
neighborhood of the affected nerve, notwithstanding that relief is af- 
forded by the injection at any point. In tic-doxdoureux, brachialgia, 
cardialgia, gastralgia, hepatalgia, nephralgia, sciatica, and pelvic neu- 
ralgice, immediate relief is afforded by this remedy, and the relief is 
not temporary and palliative merely, but curative in numerous instances. 
It appears to be especially curative in sciatica. It is a remarkable fact 
that morphine inserted under the skin, and especially in the neighbor- 
hood of affected nerves, exerts a curative power which it does not at all 
have when administered by the stomach. An efficient method of using 
morphine in the treatment of neuralgiae, according to Brown-Sequard, 
consists in applying it in a finely-divided state to the derma, denuded 
by a blister. Laf argue proposed the method of inoculation, which con- 
sists in inserting morphine into the skin by means of a lancet-puncture. 
These clumsy and painful processes are by no means equal to the hypo- 
dermatic method. 

The enchanting sense of relief to suffering wrought by opiates, and 
especially by the subcutaneous use of morphine, leads to the morphine- 
habit. It is a singular fact that in these cases the pains which were 



588 CEREBRAL SEDATIVES. 

cured by the remedy return when it is withdrawn, and other painful 
sensations appear of an even more distressing kind. In practicing the 
hypodermatic method for a long period in severe cases of neuralgia, 
the utmost care should be used to avoid the morphine-habit. 

In the neuroses of the respiratory organs, great relief is often af- 
forded by the use of opium in some of its forms. No remedial agent 
will so quickly cut short a paroxysm of asthma as the hypodermatic 
use of morphine. The paroxysms of difficult breathing which occur in 
emphysema are also readily relieved in the same way. But there is 
great danger of establishing the opium-habit in these chronic cases. 
In an allied disease — hay-fever, hay-asthma, or autumnal catarrh — 
the hypodermatic use of morphine is quite as effective as in spasmodic 
asthma. An incipient catarrh may be aborted by a full dose of Do- 
ver's powder, taken at the very outset of the inflammation, Morphine 
and quinine combined are rather more effective than Dover's powder 
in these cases. Opium, or some of its preparations, enter into the com- 
position of expectorant mixtures to allay cough. 

The hypodermatic injection of morphine has been shown to possess 
a high degree of utility in cases of dilated heart with difficult breath- 
ing, and general oedema. The eighth to the sixth of a grain suffices for 
this purpose. The effect it has is to quiet and regulate the action of 
the heart, to allay the distress of breathing, and to permit rest and 
sleep in the recumbent position. An occasional dose only is necessary 
(two or three times a week). 

Opium is a very important addition to our resources in the treat- 
ment of diabetes. It must be given in considerable doses, as Pavy has 
shown. From six to twelve grains a day are necessary, in order to pro- 
duce a decided impression. It checks the bulimia — the inordinate ap- 
petite — allays thirst, diminishes the flow of urine and the excretion of 
sugar, and, probably, arrests or prevents the changes in the nervous 
system which accompany or are causative of this disease. Although 
many cases are decidedly ameliorated, it can not be said that any have 
been cured by opium. Codeine, an alkaloid of opium, seems to be 
more effective in this disease than the crude opium or any of its prepa- 
rations. It must be given in full doses. Besides checking the waste, 
it apparently exercises an influence over the central nerve-changes, and 
thus has a curative action as well as merely palliative. 

External Uses of Opium. — A solution of morphine in distilled 
water is an excellent astringent anodyne in conjunctivitis, and, com- 
bined with atropine, in iritis. 1} Morphinae sulph., grs. iv — grs. viij ; 
aquae destil., 3 j. M. Sig. : A few drops to be put into the eye as neces- 
sary. Ijt Morphinae sulphatis, grs. iv ; zinci sulphatis, grs. ij ; aquae 
destil., 3 j. M. Sig.: Lotion for iritis and other inflammatory affec- 
tions of the eye. The last formula, omitting the zinc, is an excellent 
application in earache, the external meatus being filled with it, and in 



OPIUM. 589 

toothache, a few drop? on cotton being placed in the hollow of the 
tooth. 

Local inflammatory swellings, painful in character, can be relieved 
somewhat by poultices containing laudanum. Frictions with laudanum 
are serviceable in lumbago, sciatica, myalgia, and similar superficial 
painful affections. An infusion of opium ( 3 j — Oj), applied hot, is an 
excellent application to inflamed joints, inflamed testicle, etc. 

On the Combined Uses of Opium and Belladonna, Morphine, 
and Atropine. — The conjoined use of these agents is so important a 
subject from the point of view of practical therapeutics, that the author 
purposes to consider it under this head. Although a physiological an- 
tagonism as respects a part of their action unquestionably exists, it does 
not extend throughout their whole range of influence in the organism. 
The balance of actions furthermore produces results which neither is 
Capable of singly. Hence the importance of a more direct presentation 
of these points than has been heretofore given. 

Both act on the brain, atropine causing delirium, hallucinations, and 
disturbed sleep ; morphine producing stupor, somnolence, hebetude of 
mind. Both relieve pain, but this effect is much greater in the case of 
morphine. Both produce disorders of motility, staggering, difficulty 
of co-ordination of muscular movements, vertigo, confusion of mind, 
and headache. The reciprocal influence exerted upon each other, when 
they are administered together, modifies in a remarkable manner their 
physiological effects. 

Morphine corrects the illusions and phantasms produced by atro- 
pine. In small doses (e. g., one ninety-sixth of a grain) atropine in- 
creases the hypnotic power of morphine, with the result of causing a 
less disturbed and more nearly normal sleep than is produced by mor- 
phine alone. If, however, the quantity of atropine be in excess of 
what is necessary to establish the physiological balance in the cere- 
brum, it overrides the action of morphine and asserts its own peculiar 
power of inducing phantasms, illusions, and hallucinations. 

The pain-relieving power of morphine is rather increased than di- 
minished by atropine. The disorders of motility are enhanced by the 
mutual reactions of the two agents. The after-headache, vertigo, 
nausea, and depression of the heart's action caused by morphine, are 
to a large extent prevented by the conjoined administration of atro- 
pine. When a large quantity of opium, or morphine, is given by any 
of the modes of administration, its immediate depressing effects are 
counteracted by the simultaneous use of belladonna or atropine. 
Morphine produces contraction of the pupil, and a tetanic condition 
(according to Graefe) of the muscle of accommodation ; atropine 
causes dilatation of the pupil and contraction of the ciliary muscle. 
When used together these effects may be precisely balanced. It re- 
quires but a minute quantity of atropine to overcome the action of 



590 CEREBRAL SEDATIVES. 

morphine on the pupil. When these effects on the pupil are balanced, 
it does not follow that the muscle of accommodation is in a normal 
condition, for visual defects remain. Morphine prevents the contrac- 
tion of the arterioles produced by atropine, and, as a necessary conse- 
quence, the subsequent relaxation of the muscular fiber. 

Morphine depresses the action of the lungs ; atropine is a powerful 
respiratory stimulant. Morphine produces pallor of the surface, and 
reduces the external temperature ; atropine causes redness and injec- 
tion of the skin, and elevation of the body-heat. In some experiments 
the author ascertained that while atropine alone raised the pulse to 
105 from 72, atropine and morphine combined depressed the pulse of 
the same subject to 60. 

Both morphine and atropine produce dryness of the mucous mem- 
brane of the mouth and fauces. Morphine suspends, and atropine in- 
creases, the peristaltic movements. The sickness and nausea caused 
by morphine are, to a considerable extent, lessened or prevented by 
atropine. 

Morphine lessens and atropine increases the functional activity of 
the kidneys ; on the skin their effects are opposed ; hence, when used 
in combination, the urinary secretion is rather increased than dimin- 
ished by them. Both produce dysuria. 

Thekapeltical Applications of Opium and Belladonna. — 
Whenever opium is used to relieve pain, to procure sleep, to relax 
spasm — there being no inflammatory action present — belladonna 
should be combined with it, unless some contraindication should exist 
to the action of the latter. This formulated expression is more espe- 
cially applicable to the hypodermatic use of morphine. 

In the various psychical disorders, in which the general condition 
is sthenic, opium or morphine should be used alone. When power is 
deficient, the forces depressed, the temperature rather below than 
above the normal, belladonna or atropine should be combined with the 
opium or morphine. For the relief of insomnia the combined action 
of these agents is much more effective than either singly. The pro- 
portion in which the alkaloids should be used is about as follows : 
yl-g — j-J-g- of a grain of atropine to \ and J of a grain of morphine. 

In the various convulsive disorders in which opium or morphine 
may be used, especially hypodermatically, atropine should be combined 
with it. 

The neuralgim are best treated by morphine and atropine com- 
bined, for the following reasons : the combination is more effective, 
the after-unpleasant effects of either are prevented to a considerable 
extent. 

The neuroses of the respiratory organs, of the abdominal viscera, 
etc., are, as a rule, more successfully treated by morphine and atropine 
in combination, than by either separately. 



OPIUM. 591 

In surgical diseases and operations of various kinds, the combina- 
tion of morphine and atropine has most important and varied applica- 
tions, among which may be enumerated : to render safer and to pro- 
long ether or chloroform narcosis ; to prevent or relieve shock; to 
save suffering / to relax muscles / to facilitate operative procedures. 

The combined administration of morphine and atropine is of the 
greatest service in obstetric practice : to relieve the teasing pains of 
the first stage y to procure sleep in the course of an exhausting labor ; 
to quiet after-pains ; to facilitate the performance of various obstetric 
operations / to arrest puerperal convulsions. 

Authorities referred to : 

Albers, Dr. J. H. F. Virchovfs Archiv, Band xxvi, p. 229. 

Allbutt, Dr. T. C. The Practitioner, vol. iii, p. 342. Ibid., vol. v, p. 327. 

Anstie, Dr. F. E. Stimulants and Narcotics, American edition. Article Alcoholismus, 
Reynolds's System of Medicine. The Practitioner, vol. i, No. 1, etc. 

Asche, Dr. Schmidfs Jahrbucher, Band cxxv, pp. 331-337. 

Bartholow, Dr. Roberts. Manual of Hypodermatic Medication, fourth, edition. 

Bernard, Claude. Bulletin General de Therapeutique, vol. lxxvii, p. 241, et seq. 

Ibid. Archives Generales de Medecine, 1864. 

Bois, Dr. A. De la Methode des Injections Sous-cutanees, Paris, 1864, p. 17. 

Courtenat, Dr. E. M. West Riding Lunatic Asylum Reports, vol. ii, p. 254. 

Da Costa, Dr. J. M. Pennsylvania Hospital Reports, 1868. 

Demarquay, Dr. Bulletin General de Therapeutique, October 15, 1871, p. 229, et seq. 

Erlenmeyer, Dr. A. Die subcutanen Injectionen der Arzneimittel, dritte Auflage, 
Neuwied, 1866. 

Eulenburg, Dr. A. Die hypodermatischen Injectionen der Arzneimittel, zweite Auflage, 
Berlin, 1867, p. 96, et seq. 

Ibid. Lehrbuch der functionellen Nervenkrankheiten, Berlin, 1871, p. 166, etc. 

Fluckiger and Hanbury. Pharmacographia, p. 40, et seq. 

Fronmuller, Dr. Klinische Studien uber die schlafmachende Wirkung der narkolischen 
Arzneimittel, Erlangen, 1869. 

Harley, Dr. John. TJie Old Vegetable Neurotics. 

Hunter, Charles. On the Speedy Relief of Pain and other Nervous Affections by 
means of the Hypodermic Method, Churchill, London, 1865. 

Eusemann, Drs. Aug. und Theod. Die Pflanzenstoffe, p. Ill, et seq. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, Berlin, 1875, 
zweiter Band, p. 1055, et seq. 

Hutchison, Dr. James H. Pennsylvania Hospital Reports. 

Krafet-Ebing, Dr. R. von. Bulletin General de Therapeutique, January 30, 1870, 
p. 474. 

Lawson, Dr. Henry. Sciatica, Lumbago, and Brachialgia, London, 1872. 

Loomis, Dr. A. L. Lectures on Diseases of the Respiratory Organs, Heart, and Kid- 
neys, New York, 1875, p. 450. 

Maudsley, Dr. H. The Physiology and Pathology of the Nervous System, and Rey* 
nolds's System of Medicine. 

Medico-Chirurgical Transactions, vol. 1, p. 561, et seq. 

Mitchell, Dr. S. Weir. American Journal of Medical Sciences, 1869-'70, also in con- 
junction with Morehouse and Keen. 

Ibid. Injuries of Nerves and their Consequences. 

Nothnagel, Dr. Hermann. Handbuch der Arzneimittellehre, p. 1, et seq. 



592 CEREBRAL SEDATIVES. 

Reissner, Dr. Bulletin General de Therapeutique, January 30, 1870, p. 89. 

Robertson, Dr. C. Lockhart. The Practitioner, May, 1 869, p. 272. 

Rosenthal, M. Klinik der Kervenkrankheiten, Stuttgart, 1875. 

Stille, Dr. Alfred. Epidemic Meningitis, and Therapeutics and Materia Medica. 

Taylor, Dr. A. S. On Poisons, third edition, London, 1875, p. 547. 

Trousseau, A. Clinique Medicate, vol. ii, p. 196. 

Ward, Dr. J. Bywater. West Riding Lunatic Asylum Reports, vol. i, p. 152. 

Wolff, Dr. 0. J. B. Archiv fur Psychiatrie und Nervenkrankheiien, Band ii. 

Hunmlus. — Hops. The strobiles of Humulus lupulus Linne (Nat. 
Ord. Urticacece, Cannabinece). 

Lupulinum. — Lupuline. The glandular powder separated from 
the strobiles of II. lupus. Lupuline, Fr. ; Hopfendrilsen, Ger. 

Infusum Humuli. — Infusion of hops ( § ss — Oj). Dose, a teacup- 
ful or more. (Not official.) 

Tinctura Humuli. — Tincture of hops (twenty parts to one hun- 
dred). Dose, % ss — | ij. 

Oleoresina Lupulini. — Oleo-resin of lupuline. Dose, hi v — 3 ss 
or more. 

Extractum Lupulini Fluiclum. — Fluid extract of lupuline. Dose, 
3 ss— 3 ij. 

Composition. — Hops contain lupuline (described above), a tannic 
acid, an essential oil composed in part of valerol, trimethylamine, and 
a liquid volatile alkaloid, lupuline (?). 

Physiological Actions. — Hop is an aromatic stomachic tonic, 
and as such promotes the appetite and digestive power. It is slightly 
astringent also. The action of the heart is somewht increased, the 
cutaneous circulation excited, and diaphoresis produced. 

In a very slight degree, hop first causes cerebral excitement, fol- 
lowed by calm and a disposition to sleep. Experience has shown that 
it possesses some anaphrodisiac property, and lessens the functional 
activity of the testes and the apparatus of erection. 

Therapy. — As a stomachic tonic hop is quite as serviceable as 
many more rare and costly medicines. It is useful in atonic dyspepsia, 
simple flatulent colic, and mild diarrhoeas. 

The power of a hop pillow to quiet the mind and to induce sleep 
seems to be well established, but its influence is, doubtless, largely due 
to imagination and the association of ideas. The tincture of lupuline 
and the oleo-resin are useful remedies in mild cases of delirium tremens 
They serve a double purpose — as a stomachic tonic and cerebral seda 
tive. A combination of fluid extract or tincture of lupuline and tine 
ture of capsicum is probably the best substitute for alcoholic stimulants, 
when the habit of their use is to be discontinued. !£ Ext. Iupulina3 fluid, 
tinct. capsici, aa 3 j. M. Sig. : One or two teaspoonfuls as necessary, 
The condition known as horrors, or the wakefulness and excitement 
which just precede the attack of delirium tremens, may often be quite 
removed by free use of this combination. 



LACTUCARIUM.— BROMIDES. 593 

Nocturnal seminal losses may be reduced in frequency by the use 
of lupuline, of which the best preparation for this purpose is the oleo- 
resin. Chordee is said to be prevented by the use of lupuline, but the 
author has been quite disappointed in his attempts to relieve this state 
by this remedy. 

A hop poultice or bag is a domestic remedy for internal pains and 
inflammation, especially of the abdominal organs. A quantity of hops 
is sewed into a muslin bag, dipped in hot water, and then laid over 
the affected region. It forms a light fomentation, which owes its 
virtues rather to the heat and moisture than to the anodyne qualities 
of the hops. 

Lactucarium. — Lactucarium. The concrete milk- juice of Lactuca 
virosa Linne (Nat. Ord. Compositor). (U. S. P.) Dose, gr. v — 3 j. 

JExtractum Lactucarii Fluidum. — Fluid extract of lactucarium. 
Dose, 3 ss — | ss, or more. 

Composition. — Lactucarium contains several organic substances 
and eight to ten per cent of inorganic matter. It yields about fifty- 
eight per cent of laetucerine or lactucone, an inodorous, tasteless 
neutral substance, a crystallizable bitter principle, lactucine, and lac- 
tucic acid. 

Physiological Action, and Therapy.— The soporific quality of 
lettuce is known to all who eat this vegetable. Notwithstanding this 
universal experience, careful experiments have shown that lactucarium 
possesses a very feeble hypnotic quality, if it be not entirely inert. It 
is only used as a substitute for opium and its alkaloids when these 
disagree. The sirup of lactucarium is prescribed to relieve cough, 
but it is better employed as a vehicle for more powerful agents of the 
class of expectorants. 

Bromides. — Ammonii Bromidum. Bromide of ammonium. Bro- 
mure d"* ammonium, Fr.; Bromammonium, Ger. Colorless, transpar- 
ent, prismatic crystals, or a white, granular salt, becoming yellow on 
long exposure to air, odorless, having a pungent, saline taste, and a 
neutral reaction. Soluble in 1*5 part of water and in 150 parts of 
alcohol at 60° Fahr. ; in 0*7 part of boiling water. Dose, gr. x — 3 ss, 
or more, well diluted. 

Calcii Bromidum. — Bromide of calcium. A white, granular salt, 
very deliquescent, odorless, having a pungent, saline, and bitter taste, 
and a neutral reaction. Soluble in 0*7 part of water and in 1 part of 
alcohol. Dose, 3 j — 3 ij. 

Camphora Monobromata. — (For description, see article C amphora,) 
Ethyl Bromide. — (For description, see article ^Ether.) 
Lithii Bromidum. — Bromide of lithium. A white, granular salt, 
very deliquescent, odorless, having a very sharp, somewhat bitter 
39 



594 CEREBRAL SEDATIVES. 

taste, and a neutral reaction. Very soluble in water and in alcohol. 
Dose, gr. v — 3ij. 

Botassii Bromidum. — Bromide of potassium. Bromure de potas- 
sium, Fr. ; Bromkaliicm, Ger. Colorless, translucent, cubical crystals, 
permanent in dry air, odorless, having a pungent, saline taste, and a 
neutral reaction. Soluble in 1*6 part of water and in 200 parts of 
alcohol at 60° Fahr. Dose, 3 j— 3 ij. 

Sodii Bromidum. — Bromide of sodium. Small, colorless, or white 
monoclinic crystals, or a crystalline powder, permanent in dry air, 
odorless, saline taste and neutral reaction. Soluble in 12 parts of 
water and 13 parts of alcohol. Dose, 3 j — 3 ij. 

Antagonists and Incompatibles. — Acids, acidulous and metallic 
salts are incompatible with bromides of ammonium and potassium, and 
nitrous ether with the former. The physiological actions of the bro- 
mides are antagonized by cold, digitalis, belladonna, ergot, and other 
agents which energize the vaso-motor nervous system. 

Synergists. — Opium, chloral, and remedies belonging to the same 
group, promote the action of the bromides on the brain ; and aconite, 
veratrum viride, gelsemium, etc., increase the depressing effect of the 
bromides on the circulatory system. 

Physiological Actions. — The taste of a bromide is bitter and 
saline. In a short time after it is swallowed, the characteristic taste 
returns to the mouth, owing to the outward diffusion of a portion of 
that administered. The tactile sense of the fauces, as also the muscu- 
lar movements in the act of swallowing, are diminished by long-con- 
tinued use of the bromides. 

Sixty grains of the bromide of potassium or sodium, and a less 
quantity of the ammonium salt, will in some persons produce slight 
nausea and diarrhoea ; in others, a sense of coolness in the epigastric 
region ; but in many, provided the salt is properly diluted, no effect 
on the stomach. Gastric catarrh is undoubtedly one of the evil results 
which may follow the protracted administration of the bromides in 
considerable doses. 

These are diffusible substances, and hence pass quickly into the 
blood. When large doses are administered and insufficiently diluted, 
it is probable that no inconsiderable portion escapes absorption, for 
they can be detected in the intestinal mucus and in the faeces. 

Very obvious effects on the action of the heart, on the respiration, 
and on the animal temperature, are produced by the bromides if admin- 
istered in considerable quantity. These functions are depressed, but 
the depression is much less evident as to temperature ; hence, in order 
to determine this result, most careful observations are necessary. The 
author has ascertained that two drachms of bromide of potassium wiU 
lower the temperature in a healthy adult from one fifth to one half a 
degree ; the respirations from two to five, and the pulse from ten to 



BROMIDES. 595 

twenty beats per minute. These effects are more pronounced in ani- 
mals, as ascertained by the administration of lethal doses. In man 
the number of the cardiac pulsations is not only reduced, but their 
force is diminished, and the tension of the arterial system is lowered. 

A transient excitement, intoxication, giddiness, in some persons an 
anxious mental state, are produced by one or several large doses. As 
a rule, slight somnolence, and sounder and more refreshing sleep result, 
provided no disturbing element intervenes. The pupil is not affected 
in its size and sensibility to luminous impressions in an adult man by 
a dose of one hundred and twenty grains. When long continued, the 
hypnotic effect is much more pronounced, and a constant drowsiness 
is experienced. The sensibility to pain, but especially the sensibility 
to tactile impressions, is lowered by the bromides at all accessible 
points of the mucous membrane, and of the skin — notably of the plan- 
tar surfaces of the hand and foot. The diminution of the sensibility 
of the mucous membranes is in part due to a local action of the salt 
as it is being eliminated. 

Motility is impaired by the long-continued use of the bromides in 
man, and in animals paralysis of the muscles ensues. If injected into 
the tissues of a limb, paralysis of motion and sensibility begins in that 
member. In man the impaired motility is probably due to other fac- 
tors as well as to the action of the bromides on the muscular tissue, 
viz., to the cutaneous anaesthesia, and to an anaemia of the co-ordi- 
nating centers, in consequence of which their functional power is 
lowered. 

A very notable effect of the bromides — chiefly bromide of potas- 
sium — is the diminution of the sexual feeling and of the power of 
erections produced by it. This fact has been established by abundant 
clinical evidence. The result is not, however, produced with equal 
facility in all cases, and considerable doses are necessary in any case. 

Prolonged administration of the bromides develops a peculiar state, 
to which the term bromism is applied. This condition of chronic poi- 
soning differs from the effects of a few medicinal doses in the extent 
and intensity, but not in the character, of the symptoms. The follow- 
ing were the symptoms of bromism, as observed in an epileptic boy, to 
whom two drachms of the bromide of potassium had been administered 
daily for a month : extreme pallor and anaemia, dilated pupils, acne on 
face, forehead, and shoulders ; a fetid, bromine breath ; slow and 
feeble action of the heart ; breathlessness, and quickened pulse on 
slight exertion ; cool hands and feet ; a general subjective sense of 
coldness ; movements in walking tremulous and uncertain ; diminu- 
tion of the tactile sensibility of both cutaneous and mucous surfaces ; 
fauces dry, and the reflex movements sluggish ; swallowing somewhat 
difficult ; antaphrodisia and complete relaxation of the genitals ; mind 
weak, manifested in silly conduct and unmeaning laughter. 



596 CEREBRAL SEDATIVES. 

Various mental symptoms are in some subjects produced by the 
long-continued use of the bromides. Weakness of mind, without per- 
version of intellection, is a very constant result of the continued use of 
large doses. Headache, confusion of mind, and a peculiar intoxica- 
tion, had long ago been observed to follow the use of the bromide of 
potassium in even moderate doses (Puche). A form of mental de- 
rangement, with hallucinations of a melancholic character, has been 
observed by Hammond and others, and in a few instances a pleasura- 
ble intoxication, with exalted ideas, has been produced (Bannister). 

The pallor and anaemia of bromism are due to several causes : to 
the diminished action of the heart ; slowness of the capillary circula- 
tion, and consequent interference in the metamorphosis of tissue ; de- 
rangement of digestion and assimilation in consequence of gastric ca- 
tarrh ; and diminished blood-supply to the cerebro-spinal axis. The 
disorders of voluntary movement, the uncertain gait, the apparent 
defects of co-ordination, are variously explained ; but, they are doubt- 
less made up of several factors, of which the cutaneous anaesthesia is 
the most influential. The bromides possess the power to destroy or 
impair the irritability of the motor and sensory nerves, and the con- 
tractility of muscle, and to these effects must be attributed in part the 
disorders of voluntary movement noted above. 

It is very obvious that the bromides depress certain organic func- 
tions : they diminish the action of the heart, lower the animal tem- 
perature, and lessen the blood-supply to various organs. These re- 
sults can only be accomplished by a sedative influence on the sympa- 
thetic system. Some very accurate observers have maintained that in 
this action lies all of the physiological power of the bromides (Rey- 
nolds, Amory). 

Effects of the Bromides compared. — There is a general corre- 
spondence in the actions of the different bromides. As respects their 
influence on the pulse, body-heat, and respiration, the author's com- 
parative experiments have demonstrated that these agents stand to 
each other in the following order : bromide of sodium, bromide of 
lithium, bromide of potassium, bromide of ammonium. Very notable 
differences exist between the bromide of ammonium and the others, 
due, undoubtedly, to the character of the base. 

The author's experiments on animals further demonstrated the fol- 
lowing : bromide of potassium possesses the most toxic power, and 
bromide of sodium the least. The bromide of lithium is first, the 
bromide of sodium second, and the bromide of potassium third, in 
hypnotic power. As respects the influence of these agents severally 
on the reflex faculty of the spinal cord, it may be stated that none of 
them possess the power to abolish the reflex faculty except when ad- 
ministered in sufficient quantity to produce lethal effects. Consid- 
ered from this point of view, the bromides may be grouped as fol- 



BROMIDES. 597 

lows : bromide of ammonium, bromide of potassium, bromide of lith- 
ium, bromide of sodium. 

The elimination of the bromides takes place through the mucous 
membrane of fauces, intestinal canal, and bronchi, through the skin, 
but chiefly by the kidneys. The rate of elimination varies, but is 
usually slow, several days being occupied in its diffusion outwardly 
from the blood. 

Therapy. — In some kinds of vomiting the bromides are most ser- 
viceable. The form of vomiting, to the treatment of which they are 
best adapted, is the reflex and the cerebral — as the vomiting of cere- 
bral congestion, sea-sickness, pregnancy, etc. They are contra-indi- 
cated in all cases of vomiting due to primary gastric disturbance. 

In the abdominal neuroses, of which cholera infantum is a type, 
the bromides are often highly effective, as the author has long known, 
and as Spender has lately advocated ; but, according to the author's 
observation, it is useless, if not injurious, when defective alimentation 
is the cause of the attacks, and is serviceable just in proportion to the 
degree in which an irritable state of the nervous system dominates 
the gastro-enteric disturbance. When the cause of the attacks is 
heat, or reflex irritation of the fifth pair, as in teething, or cerebral 
congestion, very excellent results are obtained from the use of the 
bromide of potassium. IJ Potassii vel sodii bromidi, 3 ij ; syrup, 
simplicis, f ss ; aquae menthae pip., 3 jss. M. Sig. : A teaspoonful 
every hour or two. The author has had excellent results from the use 
of the bromides in the flatulent colic, the restlessness, and crying fits 
of infants. $ Potassii vel sodii bromidi, 3 j ; ol. anisi, Tq, ij ; mucil. 
acacia?, aquae menthae pip., aa § j. M. Sig. : A teaspoonful every 
half -hour until relief is experienced. 

Increased action of the heart (hyperkinesis) due to irritation of the 
sympathetic, as, for example, such as occurs in exophthalmic goitre, is 
calmed by the bromides. The irregular and too frequent action of the 
heart, occurring in hysterical subjects of plethoric constitution, is 
generally relieved in the same way ; but the bromides are contraindi- 
cated in all cases dependent on anaemia. Disturbed action (overac- 
tion) of the heart, with cerebral hyperaemia, is frequently most ad- 
vantageously treated by a combination of digitalis and a bromide : IJ 
Inf. digitalis, % iv ; potassii bromidi, § ss — f j. M. Sig. : A table- 
spoonful morning and evening. 

Da Costa has, in several publications, strongly urged the use of 
the bromide of ammonium in acute rheumatism. Doubtless, other 
bromides (potassium, sodium, lithium) would be as effective, and are 
certainly much less disagreeable. The author has used the bromide of 
lithium with considerable apparent success, in subacute rheumatism, in 
rheumatic gout, and to remove the stiffness and nodosities of joints re- 
maining after attacks of the above-named rheumatic affections. The 



598 CEREBRAL SEDATIVES. 

wakefulness, delirium, and hyperpyrexia, which sometimes complicate 
rheumatism and gout, are best treated by bromide of lithium, pain 
being relieved by morphine if necessary. 

It has been stated that the bromides, especially bromide of ammo- 
nium, diminish the deposition and hasten the retrograde metamorphosis 
of the fat in obesity. Undoubtedly these agents increase waste, but 
they do so, chiefly, in consequence of a severe gastric catarrh which 
they set up. 

Rabuteau has proposed the use of the bromides as eliminating 
agents in cases of mercurial, cupric, or saturnine poisoning. These 
agents, more efficiently than the iodides, combine with the deposited 
minerals, convert them into soluble combinations, and thus cause their 
elimination. The best results are probably obtained by a combination 
of the bromide and iodide of potassium. 

The most important therapeutical applications of the bromides of 
potassium, sodium, lithium, etc., are in the treatment of cerebral dis- 
orders from overaction. The bromides acting on the heart slow its 
movements, and, on the vaso-motor nerves, diminish the intra-cranial 
blood-supply. The best results are obtained in the treatment of cases 
in which there is no anaemia on the one hand, or inflammatory re- 
action on the other ; cases in which the intra-cranial blood-supply is 
in excess, because the vaso-motor regulating centers are wanting in 
activity. The most typical representation of this condition is seen in 
wakefulness from cerebral overwork. No clinical fact is more con- 
spicuous than that the bromide of potassium will relieve wakefulness 
of this kind. The hypnotic action of the bromides is not a certain 
action like that of chloral, nor like that of morphine under appropriate 
conditions ; considerable mental excitement and an active cerebral 
congestion may entirely prevent the hypnotic effect. Wakefulness 
from mental worry, fatigue, unrest of the peripheral nerves (fidgets), 
and similar causes, will generally be relieved by the bromides. For 
this purpose a cumulative action is generally desirable, effected by giv- 
ing a dose of fifteen grains before each meal, and one of thirty grains 
on retiring. The manner in which the hypnotic action of the bromides 
is limited by certain states of the intra-cranial circulation is well ex- 
hibited in delirium tremens. In the condition of nervous excitement 
and wakefulness which precedes the delirium, and which is known as 
" horrors," the action of the bromide is most satisfactory ; it quiets 
the restlessness and induces sleep. For this purpose considerable 
doses are necessary — a drachm every four to six hours. When, how- 
ever, delirium tremens is fully developed, this remedy is much less 
efficient, and frequently fails altogether to produce sleep. It is more 
serviceable in the first than in subsequent attacks of horrors, and its 
utility diminishes as the structural alterations of chronic alcoholismus 
increase. 



BROMIDES. 599 

In some cases of maniacal excitement the bromides produce excel- 
lent effects, but they very frequently fail without apparent reason. 
In acute mania accompanied by heat of head, injected conjunctivae, 
and restlessness, refreshing sleep may follow the administration of one 
full dose ; but the remedy fails more frequently than it succeeds. In 
puerperal mania of the sthenic form, with rather quick and full pulse, 
hot head, and injected conjunctivas, the author has witnessed excellent 
results from the use of the bromide of potassium ; but it has rather 
increased the delusions and the depression when the type of the case 
was melancholic, with systemic weakness and anaemia. A similar ex- 
perience has been had in the use of the bromides in hypochondriasis 
and melancholia. These forms of mental trouble are most usually 
accompanied by bodily weakness, and are rather increased by the use 
of the bromides ; but it occasionally happens that these agents give 
an amount of relief afforded by no other drug or combination of 
drugs. It is impossible to indicate, in the present state of our knowl- 
edge, the particular cases in which the bromides may be serviceable, 
but the author ventures to express the opinion that the state of the 
intra-cranial circulation, which may be ascertained on ophthalmoscopic 
examination, will furnish the true guide. It need hardly be ob- 
served that the bromides are useless when wakefulness is dependent 
on pain. 

Some kinds of neuralgia are much benefited by the bromides. The 
congestive form of migraine, or sick-headache, is generally quickly 
dispelled by one or more full doses. The form of migraine in which 
it acts almost as a specific is that characterized by a flushed face, 
throbbing temples, injected conjunctivae, eyes intolerant of light. The 
bromides often give great relief in the fugitive nerve-pain of hysteri- 
cal women ; but they are quite ineffectual in neuralgia fixed in a 
nerve, as, for example, in trigeminal neuralgia, sciatica, etc. The 
bromide of potassium is often quite successful in ovarian neuralgia, 
and in the nervous unrest which grows out of ungratified sexual in- 
stinct in men and women. 

Very remarkable results have been obtained by the use of large 
doses of bromide of potassium in tetanus. H. C. Wood gives a tabular 
statement of fifteen cases which he has collected, in which the bromide 
of potassium was the chief or the only agent used, and of these but 
two died. No. results equal to this have been achieved by any other 
agent, not even by Calabar bean. In order to succeed with this 
remedy it must be given in large doses ( 3 j every three or four hours). 
A combination with chloral is also highly effective, but these agents 
exert a powerfully depressing action on the heart. 

Cases of strychnine-poisoning have been reported cured by full 
doses of the bromide of potassium. One case is narrated by Dr. 
Gillespie in which three grains of strychnine were taken, and the lethal 



600 CEREBRAL SEDATIVES. 

effects were obviated by one ounce of bromide of potassium in divided 
doses. 

No therapeutical fact is better established than the influence of 
bromide of potassium over epilepsy and epileptiform seizures. But 
the curative power of this agent in epilepsy has numerous limitations. 
It has been well ascertained that bromide of potassium is most valu- 
able in those cases of epilepsy characterized by frequent and violent 
convulsive seizures. Epileptiform attacks, dependent on the presence 
of a tumor or other coarse organic lesion of the brain, are usually 
suspended by the use of this agent, although the neoplasm is un- 
affected in its growth and development. It is a curious circumstance 
that attacks, nocturnal exclusively, are less amenable to the bromide- 
treatment than those which occur in the daytime. 

Cases of the petit mal, or epileptoid seizures, in which there is tempo- 
rary loss of consciousness without convulsion, or with a transient spasm 
of the facial muscles, etc., are as a rule not so much benefited as are 
cases of the grand mal. Hysterical convulsions (hystero-epilepsy) are 
benefited by the bromide in the degree in which they partake of the 
nature of true epilepsy. Simple hysterical convulsions are rarely im- 
proved even by a course of this medicine. It has been repeatedly 
shown, as was first observed by Sir Charles Locock, that the bromides 
are especially efficacious in cases of epilepsy of sexual origin. 

Although the bromide of potassium is less effective in the epilepsy 
of childhood than of adults, it is an excellent remedy in infantile con- 
vulsions dependent on reflex irritation. After the removal of the irri- 
tation the convulsive attacks may continue, but they can be arrested 
by the use of the bromides. The cerebral congestion which precedes 
the convulsive seizure may be relieved by this agent, and the threat 
ened attack averted. The author is convinced that the convulsions 
which attend tubercular meningitis may be prevented by the bromide, 
but this agent exerts no curative influence in this fatal malady. 

In the present state of our knowledge it is not possible to indicate 
with any degree of certainty, besides the points mentioned above, the 
kind of cases in which a successful result may be expected from the 
bromide treatment. If no improvement be manifest after several 
weeks of treatment, and if bromism be induced, the case must be re- 
garded as an unfavorable one for this treatment. Brown-Sequard 
thinks that the cropping out of an " acne-like eruption on the face, 
neck, shoulders," etc., is an evidence that the bromide is proving cura- 
tive, and he even asserts that there is " a positive relation between 
the intensity of the eruption and the efficacy of the remedy against 
epilepsy." According to Yoisin, the abolition of reflex nausea — ascer- 
tained by passing a spoon as far back as the epiglottis, without causing 
attempts at vomiting — is an indication of the successful action of the 
remedy. Furthermore, he regards the following physiological effects 



BROMIDES. 601 

as evidence of curative power : "Hypnotic manifestations, general las- 
situde, an easy and rapid disappearance of reflex nausea, and antaphro- 
disiac action." 

Certain cases of epilepsy, in which the bromide of potassium fails to 
afford relief, are greatly benefited by strychnine. From this circum- 
stance it has been concluded that the former agent is most serviceable 
in cases in which a condition of hyperemia of the brain exists, and 
that the latter agent produces the best effects when a condition of 
cerebral anaemia is present. 

Various important considerations are connected with the adminis- 
tration of the bromides in epilepsy. The daily dose required varies 
from half a drachm to four drachms, the limit of the quantity admin- 
istered being determined by the effect produced. The occurrence of 
bromism and the arrest of the seizures are the evidences that a suffi- 
cient quantity has been introduced into the organism. According to 
the author's experience, forty grains of the bromide, dissolved in water 
and given before each meal, or three times a day, and if required a 
double dose at bedtime, is an artiount of the medicine which it is rarely 
necessary to exceed. When the convulsive attacks have ceased, a sin- 
gle dose of sixty grains at bedtime will generally suffice ; but this re- 
sult must not be interpreted too favorably, and the remedy discon- 
tinued, for an immense experience has now demonstrated that security 
against a return of the attacks can only be attained by a continuance 
of the remedy for two or more years after all indications of epilepsy 
have disappeared. After the continuous use nightly of the remedy 
for a year, the dose may be so far diminished as to give it on alternate 
nights. Should the attacks recur after temporary cessation, larger 
doses are required as a rule. 

The long-continued use of the bromide of potassium may produce 
very serious symptoms of bromism. The remedy must then be greatly 
reduced in amount or be discontinued, and tonics and restoratives ad- 
ministered until the organism recovers its tone. When there is much 
susceptibility to the action of the bromides, it is generally better to 
prescribe the bromide of sodium. This salt is equally effective in epi- 
lepsy, while it is much less depressing in its effects. It is not unfre- 
quently desirable to administer iron during a course of bromides. The 
author has had excellent results from the following : t£ Potassii bro- 
midi, | j ; ferri bromidi, gr. vj ; aquae, § vj. M. Sig. : A tablespoon- 
ful three times a day. Echeverria has made the observation that tak- 
ing strong coffee with the meals hinders the development of bromism. 
The troublesome and very disfiguring acne may be, in part at least, 
prevented by the conjoined administration of arsenic (three to five 
drops of liq. potassii arsenitis). Brown-Sequard, with that fondness 
for complex combinations which he has always exhibited, recommends 
the following formula for epilepsy : P> Potassii bromidi, § j ; ammo- 



602 CEREBRAL SEDATIVES. 

nil bromidi, 3 ijss ; potassii iodidi, 3j; potassii bicarb., 2>ij ; infus. 
calumbae, 3 vj. M. Sig. : A teaspoonful before each meal, and three 
tcaspootifuls at bedtime. There is probably no advantage in this com- 
bination, and it is execrable as regards taste. It is true sometimes 
better results are obtained from a combination of bromides than from 
the bromide of potassium alone. It is always advisable to combine 
the iodide of potassium with the bromides, when there is reason to 
suspect syphilitic cerebral lesions, or when degenerate changes may 
appear to be taking place. 

Vaso-motor disturbances, elsewhere than intra- cranial, are relieved 
by the bromides. " Such symptoms are, for example, sudden numb- 
ness, coldness, deadness, or pricking sensations in one or more limbs ; 
sudden distressing but indefinable feelings in the epigastrium, abdo- 
men, or hypogastrium ; or sensations akin to rigor, with much anxiety 
and palpitation, or ' fluttering,' of the heart. In such cases it may be 
observed that the local circulation is interfered with ; that, for exam- 
ple, the pulse in one arm becomes faltering, irregular in force and 
rhythm, occasionally intermitting, while that in the other arm may 
remain unaltered, and the beat of the heart may maintain its normal 
character." 

The painful flushings of the face, and the sense of fullness in the 
head, which occur so frequently at the climacteric period in women, 
may often be removed by the bromides. 

Certain of the respiratory neuroses are greatly relieved by the 
bromides. Laryngismus stridulus, when present, may be suspended 
by the prompt use of full doses, and the tendency to frequent recur- 
rence of the attacks obviated by the steady and continued use of mod- 
erate doses of this remedy. It may be combined with chloral : $ 
Potassii bromidi, 3 ij ; chloral, hydratis, 3 ss ; syrup, tolu., § ss ; aqua?, 
§ jss. M. Sig. : A teaspoonful every half hour. The bromides greatly 
relieve the spasmodic element of whooping-cough, but they do not ap- 
pear to shorten the duration of the disease. A combination such as 
given above, for a child of two years, may be prescribed in whooping- 
cough during the spasmodic stage, and in proportionally larger quan- 
tity for older children. 

In spasmodic asthma very great relief is sometimes afforded by the 
use of bromides, but these remedies lose their effect very quickly. 
The best results are obtained from a combination of the bromide with 
the iodide of potassium : 1^ Potassii bromidi, § j ; potassii iodidi, 3 ss ; 
aquse, 3 iv. M. Sig. : A teaspoonful in sufficient water every half- 
hour or hour. 

Cough which is merely reflex (stomachal, intestinal, renal, uterine, 
ovarian) can usually be cured by the bromides. It is said that a gar- 
gle of the bromide of potassium will diminish the cough of phthisis. 
The author has ascertained that it is only occasionally that such a for- 



BROMIDES. 603 

tunate result can be achieved in this way. Such a diminution of the 
sensibility of the fauces can be produced by a few large doses of the 
bromide of potassium, that this expedient has been proposed to facili- 
tate laryngoscopy and rhinoscopy. 

In certain neuroses of the genito-urinary organs, male and female, 
excellent results have been obtained by the use of the bromide of potas- 
sium. Ab?iormal sexual excitement and nocturnal seminal emissions 
may be checked by this remedy. The condition of plethora is the in- 
dication for the bromide. When the sexual organs are much relaxed, 
the erections feeble, and the seminal fluid watery, especially if there 
be such a constant stillicidium of semen as to constitute the so-called 
diurnal losses, the bromide of potassium does harm. The more nearly 
nocturnal seminal losses approach the physiological type, the more 
effective the bromides. As they act by diminishing the blood-supply 
to the erectile organs, it is obvious that they are contraindicated when 
there is debility, and when the erections are feeble. They prove com- 
pletely successful when the erections are normal as to character, but 
teasing and persistent. The various nervous disturbances growing 
out of unsatisfied sexual desire are quieted by these agents. As a 
rule, nymphomania and satyriasis dependent on cerebral lesions are 
not diminished or prevented by the bromides. 

Bromide of potassium, in full doses, has been proposed for the 
relief of chordee. The result is generally disappointing, but occa- 
sionally relief is experienced from it. Very large doses ( 3 j every 
four hours) are necessary. 

Menorrhagia, dependent on ovarian irritation, is usually promptly 
arrested by these agents. Sometimes metrorrhagia, even when due to 
a fibroid, is remarkably improved by their use, but success is not in- 
variable. 

Various functional nervous disorders associated with, or dependent 
on, derangements of the sexual system — for example, such as are 
grouped together under the term spinal irritation — are treated with 
occasional success by the bromides. It is to be noted, however, that 
a condition of general anaemia or local spinal anaemia, which usually 
coexists, is a contraindication to the use of these agents. They are 
useful in proportion to the degree of plethora present. 

Local Uses or Bromides. — Epithelioma of the face has been 
cured by applying to the ulcerated surface bromide of potassium in 
fine powder. A solution, gr. x — gr. xx to an ounce of water, is a 
useful application for allaying the itching in pruritus, prurigo, and 
similar conditions, and the powder dusted over the surface is an effec- 
tive remedy for eczema, old ulcers, etc. 

Acidtjm Hydeobeomictjm Diltttum. — Diluted hydrobromic acid. 
A liquid composed of ten per cent of absolute hydrobromic acid 
and ninety per cent of water. A clear, colorless liquid, odorless, 



604 CEREBRAL SEDATIVES. 

having a strongly acid taste, and an acid reaction. Dose, TTj, xx 
— 3 ij. 

Hydrobromic acid has many of the properties of the bromides, and 
can therefore be substituted for the latter in some cases. In the treat- 
ment of epilepsy, the acid is far inferior to the bromides. In spas- 
modic cough it has proved very useful. In angina pectoris, or car- 
diac irregularities due to acidity of the stomach, it is highly useful, 
given before meals. The tinnitus, dizziness, and headache caused by 
quinine may be largely diminished, if not wholly prevented, by the 
addition of hydrobromic acid to the solutions containing the former, 
or by giving the latter some time after. The after-nausea and depres- 
sion caused by morphine may be obviated by the simultaneous or sub- 
sequent administration of hydrobromic acid. 

Authorities referred to : 

Anstie, Dr. F. E. Neuralgia and tlie Diseases that resemble it, English edition, p. 
185. 

Bannister, Dr. H. M. The American Journal of Neurology and Psychiatry, vol. i, 
p. 369. 

Bartholow, Dr. R. The Bromides: their Physiological Effects and Therapeutical 
Uses, Fisk-Fund Prize, Providence, 1871. 

Bill, Dr. J. H. American Journal of the Medical Sciences, July, 1868. 

Browne, Dr. J. C. The Action of the Bromide of Potassium on the Nervous System 
Pamphlet. 

Brown-Sequard, Dr. C. E. Functional Nervous Affections, Part i, p. 35. 

Clarke and Amort. The Physiological and Therapeutical Action of the Bromide of 
Potassium and the Bromide of Ammonium, Boston, 1872. 

Da Costa, Dr. J. M. American Journal of the Medical Sciences, April, 1871. 

Damourette et Pel vet. Bulletin General de Therapeutique, vol. lxiii, p. 296. 

Day, Dr. Albert. Methomania, Boston, 1867, p. 30. 

Echeverria, M. Gonzales. On Epilepsy, p. 316. 

Eulenburg und Guttmann. Schmidt's Jahrbucher der gesammien Medicin, vol. 
cxxxvii, p. 158. 

Gillespie, Dr. Charles. American Journal of the Medical Sciences, October, 1870. 

Hammond, Dr. William A. On Wakefulness. 

Ibid. The Psychological Journal. 

Laborde, Dr. J. V. Archives de Physiologie Normale et Pathologique, May, 1868. 

Lewizky, aus Kasan. VirchouPs Archiv fur pathologische Analomie, 1868, p. 183. 

Pletzer, M. Schmidt's Jahrbucher der gesammten Medicin, Band cxxxix, p. 166, No. 
8, 1868. 

Rabuteau, M. Gazette Hebdomadaire, March 19, 1868. 

Reynolds, Dr. J. Russell. The Practitioner, July, 1868. 

Spender, Dr. J. Kent. Tlie British Medical Journal, 1884. 

Toisin, A. Bulletin General de Therapeutique, vol. lxxi, p. 102. 

Williams, Dr. S. W. D. On the Efficacy of the Bromide of Potassium in Epilepsy, 
etc., Churchill, 1865. 



CONIUM. C05 

AGENTS WHICH DEPRESS THE MOTOR FUNCTIONS 
OF THE SPINAL COED AND SYMPATHETIC. 

Conium. — Hemlock. The full-grown fruit of Conium maculatum 
Linne (Nat. Ord. Umbelliferce) , gathered while yet green. Cigue, Fr.; 
Schierling, Ger. 

Abstractum Conii. — Abstract of conium. Dose, gr. ss — gr. ij. 

Extractum Conii Alcoholicum. — Alcoholic extract of conium. 
Dose, gr. j — grs. v. 

Extractum Conii Fluidum. — Fluid extract of conium. Dose, 
Til ij — tii v — Tit xl. 

Tinctura Conii. — Tincture of conium. Dose, Tq, x — 3 j. 

The preparations of conium are very uncertain in strength. It is 
pretty well established that the extracts are nearly, if not quite, inert. 
The best preparations are the fluid extract and alkaloid. 

Composition. — The special powers of hemlock are due to a pecul- 
iar alkaloid (conine). This is an oily, limpid liquid, having a strong 
alkaline reaction, a peculiar odor resembling the urine of mice, and a 
specific gravity of 0*88. It probably exists in the plant in the form of 
the malate ; but, by some authorities, the acid with which it is com- 
bined is supposed to be an acid peculiar to conium, the coneic acid. 
Conine is associated with ammonia, and another crystallizable alkaloid, 
conhydrine. 

Conine is quickly decomposed by heat. Exposed to the air, it is 
soon converted into a brownish resin, and becomes inert. Hence it is 
that the preparations of conium possess but little activity, and are so 
frequently, indeed entirely, wanting in physiological and therapeutical 
effects. It is better, therefore, to administer the alkaloid, which, be- 
ing soluble in alcohol, may be administered in that menstruum, or it 
may be converted into an acetate and dissolved in a mixture of alco- 
hol and water. It is to be noted, also, that different specimens of 
conine differ remarkably in activity ; hence, whenever a new prepara- 
tion is begun, the minimum dose should be first administered until its 
real power is ascertained (Burman). 

Conine. — Dose, gr. -^ — gr. -^ — gr. -fa, or in minim-doses from th, -fa. 
— TTi ij. Half a minim of conine (pure) is about equivalent in activ- 
ity to f j of the best succus conii. The chlorhydrate and especially 
bromhydrate of conine are greatly to be preferred, not only to the pure 
alkaloid, but to any of the preparations of conium. The bromhydrate 
crystallizes in the form of colorless, prismatic needles, which are freely 
soluble in water and also in alcohol, have but little taste, and no odor 
(Mourrut). The dose of this salt ranges from ^of a grain to J, -J, 
even 1 grain. It is not actively toxic. By reason of this fact, its 
freedom from a disagreeable taste or odor, and its solubility, the brom- 



006 MOTOR DEPRESSANTS. 

hydrate is a most desirable preparation for administration, either by 
the stomach or hypodermatically. 

Antagonists and Incompatibles. — The caustic alkalies and tannic 
acid are chemically incompatible. Physiologically considered, the ac- 
tions of conium are antagonized by nux-vomica and its alkaloids strych- 
nine and brucine, by picrotoxin, and the tetanizing agents in general. 

Synergists. — Gelsemium, tobacco, veratrum viride, aconite, me- 
thyl-strychnium, hydrocyanic acid, and curara, increase the action of 
conium. 

Physiological Actions. — The preparations of conium possess a 
considerable degree of acridity, and are therefore apt to produce gas- 
tric irritation, nausea, and vomiting. These results sometimes follow 
the subcutaneous injection of conine. The active principles readily 
diffuse into the blood. What changes, if any, they induce in the blood 
are quite unknown. It is probable that they limit the power of the 
red blood-globules to convey oxygen to the tissues on which they have 
a selective action — the motor nerves. 

When an active dose of conine is administered, weakness of the 
legs and a sense of weight and fatigue of these members are first 
experienced. The eyelids become heavy and droop somewhat, and 
double vision, or confused vision, a feeling of torpor of the mind, and 
giddiness, follow. Speech is also affected as respects vocal utterance, 
but the memory for words and the faculties of mind generally are un- 
impaired. When the dose is a lethal one, paralysis of the voluntary 
muscles — first of the inferior extremities — ensues ; there is consider- 
able vertigo, the mind is torpid and indifferent but not perverted, 
speech and vision are lost, the respiration becomes labored and slow 
from paralysis of the respiratory muscles, and death occurs from as- 
phyxia, the action of the heart continuing until after respiration has 
ceased. The mind remains unclouded to the last, except when delirium 
ensues from carbonic-acid poisoning. Convulsive movements generally 
occur in animals from retention of carbonic acid in the blood, and in 
man sometimes local convulsive movements. Sensation is unaffected 
until near the close, but a subjective sense of numbness is experienced 
in the feet and legs, without actual impairment of the functions of the 
sensory nerves. The body temperature is decidedly lowered, and in a 
direct ratio to the amount of the paralysis. 

The physiological effects of conine, even when produced by decid- 
edly large medicinal doses, are hindered if not entirely prevented by 
active exercise. When the muscular weakness, the heaviness and 
sense of fatigue in the legs are first experienced, if resisted and muscu- 
lar movements are carried on, these sensations disappear, and the 
whole duration of the physiological effects is much shortened. 

The action of conine is, primarily and chiefly, on the end-organs of 
the motor nerves ; the nerve-trunks next lose their excitability, and 



CONIUM. 607 

by an extension of the paralysis the spinal cord is at last involved. 
The muscular irritability remains unaffected. According to M. Veri- 
go, the paralysis proceeds from the spinal cord, outwardly, to the ter- 
minal filaments of the motor nerves. But it is probable that this 
experimenter operated with a preparation of conine containing methyl- 
conium, which has been shown, by Crum Brown and Fraser, to affect 
first the motor columns of the spinal cord. 

No constant and characteristic post-mortem appearances seem to 
be produced by conine. The left cavities of the heart are found empty, 
and the right distended, but these are products of the mode of dying, 
and are not directly due to the action of the poison. The blood is 
generally fluid, and the coagula are soft. 

Elimination takes place by various channels, chiefly by the kidneys. 
Conine has been found in considerable quantity in the liver, lungs, and 
spleen. 

That the conium of our time was employed by the ancients, can 
hardly be doubted by any one who will read the account of the death 
of Socrates from the Athenian state poison. This remarkable story, 
which has descended to us in Plato, bears all the indications of veri- 
similitude, and its delineation of the effects, as the symptoms success- 
ively manifested themselves, are just as we see them now, in the action 
of conium on animals, and, as Harley has described them, as occurring 
in his own person. Socrates continued his sublime discourse after the 
poison had been swallowed, thus showing that his mental powers had 
not been clouded — not certainly till near the end, when, as we now 
know, carbonic-acid narcosis comes on. Plato described the slowly- 
developing paralysis, beginning below and ascending — the mental 
powers of Socrates remaining unimpaired until near the end, when his 
commands were laid on his disciples to sacrifice a cock to iEsculapius, 
which was a return to the superstitions of the age, after having con- 
demned them in the course of his ethical disquisitions before the youth 
of Athens, for which he now underwent the extreme penalty of the law. 

Therapy. — Formerly the preparations of conium were much used 
for a supposed discutient or resolvent action in glandular enlargements, 
and in certain kinds of tumors. But, since it has been shown that the 
preparation chiefly employed for this purpose (the extract) is practi- 
cally inert, the supposed cures effected in this way are justly regarded 
as examples of the post hoc. Influenced by the same considerations, 
conium was supposed to have an alterant and anodyne action in cancer. 
But, since, in the progress of physiological research, it has been shown 
that conium affects the motor and not the sensory nerves, it is no longer 
employed to relieve the pains, or to arrest the growth and diffusion, of 
cancer. It is right to add, however, that able practitioners hold that 
the discutient and resolvent powers of conium are well established in 
clinical experience (Stille). 



608 MOTOR DEPRESSANTS. 

The true uses of conium are those deduced from a consideration of 
its physiological actions. As it lowers the functional activity of the 
motor nervous system, it is indicated in those cases of disease in which 
motor activity is in excess. Very valuable results have been obtained 
by the use of conine in mania, administered with the view of subduing 
excessive motor excitement. Its real utility consists in quieting mus- 
cular agitation, and thus preventing emaciation and maniacal exhaus- 
tion. It is considered to be most suitable to the treatment of acute 
mania, without organic brain-lesion (Burman). The dose required for 
this purpose is tfi ss — ts\, iij, or subcutaneously, commencing with one 
tenth of a minim, and gradually increasing it until some characteristic 
physiological effects are produced. 

The succus conii has been used by Harley and others with success 
in chorea. The special object for which it is used in this malady is to 
quiet the excessive muscular agitation ; but, in order to accomplish 
this result, a sufficient quantity must be administered to produce distinct 
physiological effects. To quiet muscular agitation is not alone suffi- 
cient to cure chorea ; a suitable hygiene, proper alimentation, and re- 
storative agents, are indispensable. Some cases of paralysis agitans 
are remarkably benefited by conium, but it is of little avail in cases of 
sclerosis, or when important structural alterations have occurred. Co- 
nine is certainly indicated in tetanus, hydrophobia, and strychnine- 
poisoning, but hitherto it has not succeeded, probably because in- 
ert preparations were employed. The author has ascertained that 
in animals conine rather hastens than retards the lethal effects of 
strychnine. 

In whooping-cough, asthma, and laryngismus stridulus, good effects 
have been obtained by the use of conium, carried to the point of in- 
ducing its characteristic physiological effects. A priori, the best re- 
sults might be expected from the use of conium in epilepsy, but it is 
by no means comparable to the bromides. According to Echeverria, 
conium is serviceable in those cases of epilepsy " attended by cerebral 
derangement and vertigo." 

The state of blepharospasyn, which accompanies strumous oph- 
thalmia, is relieved by considerable doses of conium. It is neces- 
sary in the treatment of this, as of other motor disorders, to give 
a sufficient quantity of conium to produce sensible physiological 
effects. 

The subcutaneous injection of conine may be practiced instead of 
the stomach administration, in all of the forms of disease for which 
this remedy is prescribed. By Burman this mode of administration 
has been practiced with much success in the treatment of acute mania ; 
by Pletzer, in asthma ; by Erlenmeyer, in emphysema and angina pec- 
toris ; by Lorent, in pneumonia and pleuritis ; and by Eulenburg, in 
blepharospasm. A marked decrease in the pulse-rate, and in the tern- 



CONIUM. 609 

perature, has been observed to follow the hypodermatic injection of 
conine in these diseases. The rational indication for the use of conine 
in pneumonia and pleuritis is, to give the organs physiological rest by 
inducing a paretic state of the respiratory muscles. 

A solution of bromhydrate of conine is greatly preferable to any 
form of the alkaloid, for all purposes, but especially for subcutaneous 
injection. The following will prove useful : t> Conine bromhydratis, 
gr. viij ; aquae, vel aquae chloroformi, § j. M. Sig. : Ten minims con- 
tain one sixth of a grain. As Tiryakian and also Tuloup have shown, 
the effects of this agent decline by repetition, and hence the dose must 
be increased every few days. Two doses every twenty-four hours will 
usually be sufficient to maintain a constant effect. By the authors 
above mentioned, by Dujardin-Beaumetz, Prevost, Rochefontaine, and 
others, it is asserted to be very effective in spasmodic affections, espe- 
cially of the respiratory organs — in whooping-cough, asthma, dyspnoea, 
laryngismus stridulus, spasm of the glottis, hiccough, etc. It has been 
used with success in tetanus by'Chisolm and by Cory. 

Conine and Morphine. — The effects of conine are in every way 
heightened by morphine. These agents have been very successfully 
employed in acute mania, conjointly administered subcutaneously. 
" Conine acting on the purely motor centers, in a sedative manner, 
and morphine acting in a similar way on the sensori-motor and ideo- 
motor centers, it follows, as a fair corollary, that the combination of 
the two, in subcutaneous injection, should lead to effects directly an- 
tagonistic to the condition of maniacal excitement ; and, such being 
in fact the case, they may be thus used together with very great suc- 
cess in the treatment of mania." When nerve-pain and muscular 
spasm coexist, the best results may be expected from the combined 
administration of morphine and conine. 

Authorities referred to : 

Burman, Dr. J. Wilkie. West Riding Lunatic Asylum Reports, vol. ii, p. 1. 
Curtis, Dr. Edward. The Medical Record, Nos. ccxxxvii, ccxxxviii, 1875. 
Erlenmeyer, Dr. A. Die subcutanen Injectionen, p. 74. 
Eulenburg, Dr. A. Die hypodermatische Injectionen, p. 239. 
Fluckiger and Hanbury. Pharmacographia, p. 266. 
Harley, Dr. John. Old Vegetable Neurotics, English edition, etc. 
Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band, 
p. 925. 

Husemann, Drs. Theod. und Aug. Die Pflanzenstoffe. 
Kolliker, Prof. Dr. A. VirchovPs Archiv, Band x, p. 228, 
Lorent, Dr. E. Die hypodermatischen Injectionen, p. 42. 
Pel yet et Damoctrette. Archives Generates, sixierne serie, tome vi, p. 87. 
Peltzer, M. Quoted by Eulenburg, supra, 
Taylor, Dr. A. S. On Poisons, third edition, p. 731. 
Von Praag, L. Schmidt's Jahrbucher der gesammten Medicin. 
Vkrigo, M. The Practitioner^ vol. vii, p. 58. 
40 



610 MOTOR DEPRESSANTS. 

Curara, or Woorara. 

History. — There are no official preparations. The substances 
known under this name vary much in purity, and differ in origin. 
True curara is a poisonous substance, prepared by the Indian tribes of 
certain districts of South America, and known under the names woo- 
rara, urari, wurali, etc. A specimen examined by Mitchell and Ham- 
mond consisted of two distinct preparations named respectively carro- 
val and vao, the former more closely corresponding to the European 
specimens. Curara is obtained for the most part from several plants 
of the Strychnos family, as Strychnos toxifera, S. cogens, and from 
Paulinia cururu. An extract from these plants, it is supposed, is 
mixed with the venom of certain poisonous reptiles, and possibly with 
other animal substances. As the arrow-poison of different tribes differs 
not only in strength, but in the character of the effects produced by 
them, it is certain that they are derived from different sources. That 
which is now obtained in commerce as curara, and which agrees in the 
main with the description of Bernard, is the substance referred to in 
this article. 

Composition. — Curara occurs in small, irregular masses, of a dark- 
brownish color, somewhat slimy, and looking like a* dried vegetable 
extract. The mass is in part soluble in water, and the undissolved 
residue is composed, for the most part, of starch-granules, vegetable 
cells, oil-drops, and other vegetable structures (Mitchell and Ham- 
mond). The existence of an alkaloid in curara had been suspected by 
Boussingault, but it was not actually discovered until 1865, when it 
was isolated by Preyer (curarine). The estimates formed of its ac- 
tivity vary : by Preyer it was held to be twenty times stronger than 
the crude drug, but by Beigel only six times ; but these differences are 
readily accounted for in the varying qualities and activity of curara. 

Curarine, one of the alkaloids, is crystallizable, deliquescent, and 
forms with acids salts, which are also crystallizable. The dose will 
range from -^ gr. to fa gr. by the stomach — from -^ gr. to ^ gr. 
when administered subcutaneously. A larger quantity may be neces- 
sary when distinct physiological effects are to be produced. 

Another alkaloid has since been discovered by Bohm, and to this 
he has assigned the name curine. 

The dose of woorara or curara, the crude drug, will range from fa 
gr. to \ gr. It is desirable to try on some inferior animal the activity 
of any new specimen before using it on man. 

Antagonists and Incompatibles. — As curara is a paralyzer, it is 
antagonized by those agents which act in the opposite manner on the 
spinal cord. From the physiological standpoint, strychnine and atro- 
pine are appropriate antagonists, opposing the tendency to death by 
failure of respiration. Remarkable results have been obtained in ani- 
mals by artificial respiration. An animal will recover from twice the 



CURARA. 611 

fatal quantity, if respiration be kept up until elimination occurs, which 
is speedy. As in the case of the other alkaloids, curarine is destroyed 
by the caustic alkalies. 

Synergists. — The paralyzers in general, especially the respiratory 
group, promote all of the actions of curara. 

Physiological Actions. — The taste of curara is bitter. Applied 
to the unbroken integument, it is not absorbed ; but swallowed, it slow- 
ly diffuses into the blood, and produces characteristic effects. Vul- 
pian finds that it is absorbed more rapidly when injected into muscular 
masses than when simply thrown under the skin. According to the 
observations of Voisin and Liouville, made on man, the salivary, nasal, 
and lachrymal secretions are increased. It is probable that the gastro- 
intestinal secretions are also promoted. The rate of diffusion into the 
veins from the stomach varies, but it takes place in from twenty min- 
utes to a half -hour ; but even a longer time than this may be required. 
The action of the heart increases ; the pulse rises a number of beats 
and may be dicrotic ; the temperature ascends two to three and a half 
degrees, and the respirations are accelerated, four to eight times per 
minute being added to the usual rate. Yoisin and Liouville ventured 
on the exhibition of larger doses with the following result : the symp- 
toms began by a more or less violent chill ; the heart beat rapidly, 
reaching 140, and the pulse became weak ; the respiration was labored 
and sighing ; the temperature rose, and double vision, sometimes with 
mydriasis, sometimes with myosis, set in. The legs became weak, co- 
ordination was destroyed, and the vertical position could not be main- 
tained. The mind continued undisturbed. The paralysis disappeared 
after a short time, but a sense of fatigue persisted in the limbs for 
some hours. The increased temperature was accompanied by the 
usual symptoms of fever — there were, besides the accelerated pulse 
and respiration, headache, thirst, and perspiration. 

It was by means of curara that Bernard demonstrated the exist- 
ence of contractility as an independent endowment of muscular tissue. 
Curara, by poisoning the end-organs of the nerves in the muscles, sepa- 
rated these organs, and thus permitted a study of the agency of each. 
In all classes of animals, as in man, curara induces paralysis of move- 
ments : locomotion, the erect posture, breathing, finally the heart's ac- 
tion, are arrested. The paralysis induced by curara is not due to an 
abolition of the excitability proper to the motor nerve-trunks, but to a 
modification set up in the terminals of the intra-muscular nerves. This 
fact is proved by the well-known experiment of Bernard, repeated by 
Kolliker, Zeleuski, Vulpian, and numerous other experimentalists, in 
which a frog is paralyzed by curara in all parts of the body except 
one limb which has been ligatured to prevent the access of the poison 
to it. The muscles of the unpoisoned limb react normally to stimula- 
tion, to the will, and to reflex impressions from distant parts. The 



012 MOTOR DEPRESSANTS. 

muscles of the poisoned parts of the body act on direct stimulation, 
but not by the will nor by any direct or reflex excitation conveyed by 
the ne'rve. The paralysis must therefore be due, as above stated, to 
the effect of the poison on the terminals of the nerve in the muscular 
tissue. As movements can be induced in the muscles of the unpoi- 
soned limb by irritation of the skin at a distant point, it is clear that 
the sensory nerves and the reflex function of the spinal cord continue 
active. It has been abundantly demonstrated that in curarized ani- 
mals the spinal cord preserves its functions for a long time. If, how- 
ever, a large quantity of the poison is administered, and a fatal result 
prevented by artificial respiration, the excitability of the cord is at first 
increased but afterward paralyzed (Yon Bezold, Yulpian, etc.). The 
motor and sensory nerve-trunks are also finally affected, but this is a 
secondary action, and ascertainable in curarized animals only by main- 
taining artificial respiration a sufficient length of time. It follows, then, 
that all parts of the nervous system are ultimately paralyzed. The 
action begins in the end-organs of the motor nerves, and then grad- 
ually extends to all parts, if the dose is large enough and life is main- 
tained by artificial respiration. 

Curara also acts on the accelerator nerves of the heart, at first stim- 
ulating and afterward paralyzing them. The action of the heart is 
increased, also, by the paralyzing effect of curara on the terminals of 
the pneumogastric, thus removing the inhibition. So decidedly is the 
vagus affected by full doses of curara, that galvanic irritation does not 
arrest the movements of the heart (Von Bezold). Notwithstanding 
the increased action of the heart, the blood-pressure is lowered by cu- 
rara, due doubtless to a paralyzing action on the organic muscular fiber 
and consequent dilatation of the vessels. The effect of curara on the 
sympathetic is variously interpreted. According to Yulpian, the iris 
contracts on changes in the amount of light falling on the retina in 
curarized animals ; the pupils dilate on faradization of the skin ; dila- 
tation of the vessels of the posterior members and an elevation of tem- 
perature take place in a curarized dog on f aradizing the central portion 
of the corresponding sciatic ; very energetic reflex contractions of the 
stomach, intestines, and bladder are obtained in curarized animals by 
f aradizing the skin of different regions of the body (Yulpian). These 
facts indicate that curara does not destroy but rather stimulates the 
functions of the sympathetic. Curara acts on the lymph-vessels of 
frogs. According to Tarchanoff, the liquid which accumulates during 
curarization grows richer in leucocytes ; also the blood contained in 
the vessels becomes more concentrated, the relative proportion of red 
globules being increased. As the accumulation of leucocytes takes 
place in the lymph-sacs, there is a corresponding diminution of them 
in the blood. These changes are due to the paralysis of the peripheric 
vessels (Tarchanoff). 



CURARA. 613 

Curara, as has been stated, produces an obvious rise of temperature 
in the extremities. This is supposed to be due to paralysis of the pe- 
ripheral vessels. In the interior of the body, however, there ensues an 
equally constant decline of body-heat (Tscheschichin, Rohrig und 
Zuntz). This lowering of the central temperature is due to the loss 
of heat at the periphery by the cooling of the blood detained in the 
superficial vessels. 

Bernard long ago ascertained that curarized animals became dia- 
betic. It seems probable that this result is due to the paralysis of the 
vessels of the liver. On the other hand, Bock and Hoffmann have ap- 
parently demonstrated that the production of glycosuria is the result 
of increased activity of the liver. It may be due to the fact that the 
sugar formed does not undergo oxidation, for Jolyet has ascertained 
that in curarized animals the excretion of carbonic acid is much below 
the amount in health. By reason of the changes in the vascular sup- 
ply, curara affects the functional activity of various organs. The in- 
creased production of saliva, and of the nasal and intestinal secretions 
noted at the outset, is due, there is little doubt, to this fact. 

The elimination of curara takes place chiefly by the kidneys, but 
some escapes with the faeces (Koch). The urine of a curarized animal 
will poison another animal, and this may be repeated to several sub- 
jects. The retention of the urine charged with curara, in the bladder, 
will continue the effects of the poison by reabsorption. This state- 
ment has been the subject of considerable controversy. It has been 
denied that the mucous membrane of the bladder possesses the power 
to absorb again into the circulation poisons dissolved in the urine in 
the process of excretion. Brown-Sequard appears to have been the 
first to prove, by direct experiment, that alkaloids could be thus ab- 
sorbed, and some recent observations have confirmed the accuracy of 
his experiments. In respect to curara, as to other organic alkaloids, 
when poisoning occurs, it is an obviously proper expedient to keep the 
bladder empty, if necessary, by catheterization. 

Therapy. — The applications of curara to the treatment of disease 
follow from the results of the physiological study. Being a motor and 
not a sensory paralyzer, it is adapted to the treatment of muscular 
cramp and spasm. It is one of the remedies employed against strych- 
nine-poisoning, and although from the theoretical standpoint such 
treatment may seem proper, yet in actual practice it has not succeeded. 
That a remedy obtained from members of the strychnos family, and a 
paralyzer in action, should antagonize strychnine, is a remarkable fact. 
In the process of preparation employed by the Indians, it is in a high 
degree probable that methyl strychnium is formed, and this substance, 
as was originally shown by Crum-Brown and Fraser, is a paralyzer, 
and acts precisely like curara. Curara has been used with a limited 
measure of success in tetanus. In the successful cases — for example, 



6U MOTOR DEPRESSANTS. 

that narrated hy Mr. Spencer Wells — large doses were administered. 
According to the statistics of Demme, of twenty-two cases of tetanus 
treated by this agent, eight recovered. Other methods have certainly 
succeeded better. Two cases of hydrophobia have been reported in 
which a cure followed the use of curara. One of these, reported by 
Dr. Watson, was examined, and the diagnosis confirmed by Dr. Flint, 
of New York. The first dose was -^ gr., and subsequently \ gr. and 
\ gr. were given. The value of this statement is impaired by the fact 
that the different specimens vary so much in activity. M. Vella has 
successfully treated a case of tetanus by cutaneous absorption of the 
agent ; but the usual mode of administration has consisted in the sub- 
cutaneous injection. This subject, as M. Vulpian has well said, has 
lost its interest since the discovery of the utility of chloral. It is in 
a high degree probable, however, that curara would be greatly more 
successful if it were pushed in these cases to obtain its full physiologi- 
cal influence, and the complete suspension of the spasms. 

By Voisin and Liouville curara has been extensively employed as 
a remedy for epilepsy. The facts already mentioned in regard to the 
action of this agent in producing febrile phenomena were obtained 
from the experiences with epileptics. They find that attacks may be 
prevented, and the condition of epileptics much improved, by the 
timely administration of this remedy. 

It has proved useful in chorea, in tic-douloureux (Beigel, Du Cazal), 
but other remedies are doubtless better. 

Authorities referred to : 

Beigel, Dr. H. Journal of Anatomy and Physiology, vol. ii, p. 329. 

Bernard, Cl. Legons sur les Effete des Substances Toxiques et Medicamenteuses, Paris, 
1857, p. 238. 

Bohm, Dr. R. Beitrage zur Physiologie, 1886, p. 173. Quoted by Virchow und HirscK's 
Jahresbericht for 1886. 

Hammond and Mitchell. The American Journal of the Medical Sciences, July, 1859. 
Experimental Researches regarding Carroval and Vao. 

Kolliker, A. Virchowh Archiv, Band x, p. 3. Physiologische Untersuchungen uber 
die Wirkang einiger Gifte. 

Riegel, Dr. Franz. Centralblatt f. d. med. Wiss., 1871, p. 401. Ueber den Einfuss 
des Curare auf die Korper temper atur. 

Tarchanoff, M. J. Archives de Physiol. Norm, et Path., January and February, 1875. 
De V Influence du Curare sur la Formation de la Lymphe et V Emigration des Globules 
Manes du Sang. 

Voisin et Liouville. Gaz. Hebdom., Nos. 32-37, 1866. 

Vulpian, A. Legons sur V Action Physiol, des Substances Toxiques et Medicamenteuses, 
Paris, 1881, pp. 193-422. 

Watson, Dr. American Journal of the Medical Sciences, July, 1876. 

Zeleuski, Dr. Virchow's Archiv, Band xxiv, p. 362. Zur Frage von der Muskel 
irritabilitat. 

Gelsemium. — Yellow jasmine. The rhizoma and rootlets of Gelse- 
mium sempervirens Aiton (Nat. Ord. Loganiaeeai). 



GELSEMIUM. 615 

Extractum Gelsemii Fluidum. — Fluid extract of gelsemium. Dose, 
tti ij— tti x. 

Tinctura Gelsemii. — Tincture of gelsemium. Dose, tti v — tti, xx - 

The so-called gelseminine is obtained by evaporation of the tinc- 
ture, and is a very uncertain preparation ; the dose is gr. ss — gr. ij. 
It is only used by the eclectic practitioners. 

Disappointment is frequently experienced from the use of gelse- 
mium preparations, owing to the fact that they are made from the 
dried root. In the process of drying, even spontaneously, the alkaloid 
disappears. The most trustworthy preparations are the official, pre- 
pared conscientiously from the fresh root. 

Composition. — Gelsemium contains a very powerful alkaloid — gel- 
semine or gelsemina — and gelsemic or gelseminie acid, by some said to 
be identical with cesculin ; but Wormley has shown the fallacy in the 
evidence on which this statement was based, and Fredigke's account 
of gelsemic acid agrees with Wormley's in all essential particulars. 
It contains also an acrid resin, volatile oil, gallic acid, a yellow color- 
ing-matter, besides some other unimportant ingredients. 

Gelsemine. — In its pure state gelsemine (gelsemia) is a colorless, 
odorless solid, having an intensely persistent, bitter taste. It has 
strongly basic properties, completely neutralizing the most powerful 
acids, forming salts of which the sulphate, nitrate, chloride, and acetate 
are freely soluble in water (Wormley). Dose, gr. -^ — gr. ■£$. 

Antagonists and Incompatibles. — The caustic alkalies and tan- 
nic acid are chemically incompatible. As respects the physiological 
actions, gelsemium is antagonized by the diffusible stimulants, by 
alcohol, ammonia, opium, digitalis, etc. The lethal effects are best 
treated by emetics, warmth, alcoholic stimulants, by faradization and 
artificial respiration, by morphine subcutaneously, and, according to 
Fredigke, by the tincture of xanthoxylum fraxineum. 

Synergists. — Conium, physostigma, tobacco, opium, etc., when ad- 
ministered with gelsemium, increase its effects in the whole sphere of 
its physiological activity. 

Physiological Actions. — The preparations of gelsemium have a 
bitter and somewhat aromatic taste, and a narcotic odor. They do not 
produce gastric irritation. The active substance, being crystalloidal, 
diffuses into the blood with facility. In moderate doses, but sufficient 
to produce decided physiological effects, gelsemium causes a feeling of 
languor and mental calm, slowing of the action of the heart, drooping 
of the eyelids, dilatation of the pupil, and some feebleness of muscu- 
lar movements. In larger doses the physiological effects are as fol- 
lows : vertigo, double vision, amblyopia, paralysis of the levator pal- 
pebrae so that the upper eyelid can not be raised, dilated pupil, labored 
respiration in consequence of a paretic state of the respiratory muscles, 
slow and feeble action of the heart, great muscular weakness, and sen- 



616 MOTOR DEPRESSANTS. 

sibility to pain and touch much reduced. These effects are produced 
in about a half -hour after the stomach administration, and last two or 
three hours, when they subside. When lethal doses are taken, the 
above-described symptoms occur in a more intense degree. The gait 
is at first staggering, but the power of muscular movement soon ceases, 
and a sense of numbness diffuses over the body. The eyelids close 
(paralysis of the levator), the pupils dilate widely, vision is. lost, and 
the pupils cease to respond to the stimulus of light. The lower jaw 
drops, and the power of speech is lost in consequence of paralysis of 
the muscles of the tongue. The respirations are labored, shallow, and 
irregular ; the action of the heart weak, feeble, and intermittent. Gen- 
erally the skin is covered with a profuse perspiration, but no other 
evacuation takes place. Death occurs from asphyxia, and the action 
of the heart ceases after the respiratory movements. Consciousness is 
preserved until near the close, and until carbonic poisoning ensues. In 
one instance (Wormley) extreme restlessness was noted, but generally 
there is a condition of calm, a soporose state, or the unconsciousness of 
carbonic-acid narcosis, and convulsions never occur. 

The author's investigations have demonstrated that gelsemium is a 
paralyzer of motility and sensibility ; that sensibility is first affected in 
cold-blooded animals (frogs), and afterward motility, and that in warm- 
blooded animals the motility is affected before sensibility. As respects 
the seat of the action, the author has ascertained that the end-organs 
of the motor nerves, and the nerve-trunks, do not lose their irritability, 
and that the muscular contractility is unimpaired. " Its paralyzing 
effect is due to its action on the motor center, and not to an action on 
the peripheral nerve-fibers. It acts also on the sensory portion of the 
cord, producing at last complete anaesthesia ; but this effect in warm- 
blooded animals, and in man, is toxic only, and follows the paralysis of 
the motor functions." Applying the precise observations which are 
made on animals to the explanation of the lethal effects which have 
occurred in man, we are conducted to the following conclusions : the 
disorders of voluntary movement, and the more or less complete pa- 
ralysis of the motor and of the sensory functions, are due to the effects 
of gelsemium on the motor and sensory portions of the cord, the func- 
tions of the sensory columns resisting longer the action of the poison. 
The labored respiration is due to the paretic state of the respiratory 
muscles, especially of the diaphragm. The depressed action of the 
heart is probably secondary to the diminished respiration movements, 
which produce this result by impeding the flow of blood through the 
pulmonary capillaries. The dilated pupil, the double vision, the ptosis, 
are due to paralysis of the third pair. 

In rabbits and cats gelsemium, in lethal doses, affects motility in a 
very remarkable manner : when the paralyzing effects are becoming 
manifest — first in the fore extremities — these animals perform a series 



GELSEMIUM. 617 

of backward movements, in which sometimes a complete backward 
somersault occurs. In pigeons, general muscular tremors precede the 
backward movements. No corresponding acts have taken place in the 
fatal cases. observed in man. A very considerable reduction of tem- 
perature occurs from lethal doses in warm-blooded animals. 

The author's experimental observations on the physiological actions 
of gelsemium have since been fully confirmed by Ott, by Ringer, and 
by O. Berger, in an elaborate series of investigations. The study of 
Ringer and Murrell is a model of a research of this kind. 

Therapy. — Gelsemium is indicated in those maladies in which an 
exaltation of function has taken place in the motor and sensory spheres 
of the nervous system. Several cases of tetanus have been reported 
cured by this remedy ; but it is impossible to say whether these were 
examples of post hoc or propter hoc. A priori it might be expected 
that gelsemium would prove serviceable in this disease, because its ac- 
tion on the spinal cord is opposed to that which takes place in tetanus. 
In strychnine-poisoning in animals, however, the tetanic spasms are not 
prevented by the administration of gelsemium. In mania, with great 
motor excitement and wakefulness, this remedy is more useful than 
conium. To bring about the best results from its administration, doses 
of sufficient strength must be given to produce definite physiological 
effects, viz., dilated pupil, drooping of the eyelids, and a feeling of 
languor. In the condition of " horrors " from alcoholic excess, in sim- 
ple wakefulness, in the insomnia which results from over-excitement 
and too great physical activity, cures are not unfrequently obtained 
by the use of gelsemium. In the inflammatory affections of the me- 
ninges, and in cerebrospinal meningitis, sporadic or epidemic, with a 
decided febrile reaction, this agent is extremely useful in small doses 
(m v of fluid extract), repeated every two hours so as to maintain a 
uniform physiological effect. 

Gelsemium has been used with success recently in the treatment of 
neuralgia of the fifth nerve, but the good effects of the remedy in the 
painful affections of the fifth nerve are not always manifest (Berger). 
Cases cured by this remedy were, doubtless, not instances of tic- 
douloureux, but nerve-pain caused by cold, rheumatism, or temporary 
excentric irritation. Intercostal neuralgia, sciatica, and especially my- 
algia, are frequently cured by this agent (Jurasz) ; but considerable 
doses are necessary — from five to twenty minims of the fluid extract 
every three hours until the characteristic drooping of the eyelids, dila- 
tation of the pupil, and muscular languor, manifest themselves. 

In convulsive or spasmodic cough, gelsemium often affords remark- 
able relief. It is beneficial in the spasmodic stage of whooping-cough, 
reflex cough from irritation of the laryngeal nerves, the irritative 
cough of phthisis with scanty expectoration, and the nervous cough of 
hysterical subjects. In some cases of spasmodic asthma great relief 



618 MOTOR DEPRESSANTS. 

is afforded by gelsemium, but, as is the case with all other remedies 
for asthma, it frequently fails and loses its good influence even in those 
cases in which it was at first successful. 

The author has witnessed excellent results from the use of gelse- 
mium in acute inflammations of the lungs and pleura. In pneumonia 
it affords rest by diminishing the activity of the respiratory function ; 
it allays cough, and, by depressing the cardiac movements, it lessens 
stasis of the pulmonary capillaries and lowers the temperature. It is 
better to give medium doses (fit iij — iq, v of the fluid extract), every two 
hours, to maintain a constant effect within the limits of safety. It 
favors, when exhibited in this way, the occurrence of an early crisis, 
and assists in the production of one critical evacuation — the sweat. A 
similar mode of administration should be pursued in pleuritis, in which 
its use is equally rational and effective. 

Very great relief is afforded by the use of gelsemium in certain 
pelvic disorders in women. There is no more generally-useful medi- 
cine in ovarian neuralgia. The pains of dysmenorrlicea are also greatly 
alleviated by it. The evidence is conclusive that this remedy also 
suspends after-pains, and it is held by some good observers that it 
quiets the " nagging " pains of the first stage of labor. In these dis- 
orders of the female sexual organs, it is generally necessary to admin- 
ister a quantity of the remedy sufficient to produce some of its charac- 
teristic physiological effects. According to Bulkley, it is an effective 
remedy for the relief of pruritus, and has given excellent results in the 
treatment of eczema. He prescribes from three to ten drops of the 
tincture, giving it every two or three hours until some of its charac- 
teristic effects appear. 

The first empirical use of gelsemium was in the treatment of the 
remittent or so-called bilious fevers of the South. A considerable num- 
ber of facts have been accumulated, which show that this remedy 
exercises a really beneficial influence in remittent and typo-malarial 
fevers. It is not an action of specificity — like quinine in intermittent 
and remittent fevers — and it is doubtful whether this supposed bene- 
ficial effect has any proper basis. 

Authorities referred to : 

Bartholow, Dr. Roberts. Experimental Investigations into the Actions and Uses of 
Gelsemium Semper virens. The Practitioner, London, vol. v, p. 200. 

Berger, Dr. 0. Berlin, klin. Wochenschrift, Nos. 43 and 44, 18*75. 

Bulkley, Dr. L. Duncan. New York Medical Journal, May, 1881. 

Fredigke, Dr. Annuaire de Therapeutique. Articles — Acide Gelseminiqne and Gel* 
semine. 

Holmes, M. Du Gelsemium Scmpervirens. Annuaire de Therapeutique, 1877, p. 41. 

Jurasz, Dr. Centralblatt f. d. med. Wissensch , No. 31,1875. 

Ott, Dr. Isaac. On Gelsemia, pamphlet, 1865. Also, Philadelphia Medical Times, 
vol. v. 

Porcher, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 501. 



ARNICA-ROOT. 619 

Wormley, Dr. Theodore. A Contribution to our Knowledge of the Chemical Compo* 
sition of Gelsemium Sempervirens. American Journal of Pharmacy^ vol. xlii, January, 

mo. 

Arnicae Flores. — Arnica-flowers. The flower-heads of Arnica mon- 
tana Linne (Nat. Ord. Compositce.) 

Amic8B Radix. — Arnica-root. The rhizoma and rootlets of Arnica 
montana. Racine d'arnica, Fr. ; Arnicaicurzel, Ger. 

Extractum Arnicm Hadicis. — Extract of arnica-root. Dose, gr. j — < 

Extractum Arnicm Hadicis Fluidum. — Fluid extract of arnica-root. 
Dose, tti v — ttl x. 

Tinctura Amicoe Hadicis.— Tincture of arnica-root. Dose, ttl x — 
T\[ xxx. 

Tinctura Arnicas, Florum. — Tincture of arnica-flowers. Dose, tti, x 
— 3 ss. 

Composition. — The chemistry of arnica has not as yet been thor- 
oughly elucidated. Walz has isolated a principle (arnicine). The 
root contains an essential oil on which depends, in great part, its physi- 
ological activity. The oil is a complex substance. One of its most 
important constituents is trimethylamine, or an analogous principle. 

Antagonists and Incompatibles. — The actions of arnica are an- 
tagonized by ammonia, alcoholic stimulants, opium, camphor, etc. 

Synergists. — Aconite, veratrum viride, digitalis, and arterial seda- 
tives generally, increase the effects of arnica. 

Physiological Actions. — Arnica excites considerable irritation of 
the skin, if the contact be sufficiently prolonged. It produces when 
swallowed a sense of heat and acridity in the fauces, and increases the 
flow of saliva. It is decidedly irritant to the stomach, and causes in 
large doses nausea and vomiting, and choleraic diarrhoea. Its active 
principles diffuse into the blood. In small medicinal doses arnica in- 
creases the action of the heart and arteries, and excites the functions 
of the skin and kidneys. In large doses, probably after a short stage 
of excitement, depression of the circulation, of the respiration, and of 
the animal temperature, ensues ; violent headache is experienced, the 
pupils are dilated, and paresis of the muscular system comes on. In 
toxic doses arnica paralyzes the nervous system of animal and organic 
life, and death ensues in a condition of collapse. 

Therapy. — In febrile diseases and inflammations, when there is 
sthenic reaction, arnica in full doses depresses the action of the heart 
and lowers the arterial tension. It is, therefore, antipyretic. For the 
production of this effect, an infusion is probably a better preparation 
than the tincture. When, however, in febrile diseases there is present 
the condition of asthenia, small doses of the tincture (five minims) are 
to be preferred. That this remedy will produce different results, in 



6:20 MOTOR DEPRESSANTS. 

small or large doses, need not occasion surprise. It is conceded on all 
sides that the effects of opium differ according to the size of the dose, 
and the frequency with which it is repeated. 

Good results have been obtained from the use of arnica infusion in 
mania and melancholia. The tincture of arnica is exceptionally ser- 
viceable in delirium tremens, with depression. 

In rheumatism and rheumatic gout, very decided curative effects 
are sometimes procured from arnica. The fact that it contains trime- 
thylamine is probably the true explanation of its utility in these affec- 
tions. It has also proved very efficacious in acute eczema, in erysipe- 
las, and other cutaneous affections of gouty and rheumatic origin. 
Dysmenorrhoea of the congestive form, acute metritis, and other acute 
pelvic inflammations, are also favorably influenced by the administra- 
tion of arnica. 

The tincture of arnica has a popular reputation for the relief of 
sprains, bruises, and external inflammations. The author has known 
violent erysipelatous inflammation to follow its application to a sprained 
ankle. It is extremely doubtful whether the good effects are more de- 
cided than those of a spirit-lotion. The infusion or decoction does not, 
it is said, cause local irritation. Planat has demonstrated that arnica 
is a remarkably effective application to boils. He directs one part of 
the extract and two parts of honey to be thoroughly incorporated, and 
the paste spread on some adhesive plaster, leaving a margin to secure 
its adhesion to the skin. The plaster is renewed every twenty-four 
hours. To increase the effect, Planat gives by the stomach the tinc- 
ture of arnica. 

Authorities referred to : 

' Husemann, Dr. Theodor. Handbuch der gesammten Arzncimittellehre, zweiter Band, 
p. 978. 

Phillips, Dr. C. D. F. Materia Medica and Therapeutics, p. 305. 

Planat, Dr. Proprietes de V Arnica. JDAbeille Medicate, 18S0. In Annuaire de The- 
rapmtique, 1880. 

Trimethylamine. — (Unofficial.) This is an ammoniacal substance, 
having a strong, fishy odor. It is isomeric with propylamine, which is 
also an ammonia. As the propylamine of commerce is a mixture of 
various substances, and is of uncertain composition, trimethylamine 
only should be used (Spencer). The dose of trimethylamine is four 
to eight minims. Its disagreeable taste may be disguised somewhat 
by peppermint-water. 

Properties. — Trimethylamine is a colorless liquid, having the 
composition C 3 H 9 N. It dissolves freely in ether, alcohol, and water, 
has a strong alkaline reaction, and is inflammable. 

Chloride of Trimethylamine is a stable salt which crystallizes in 
long needles ; it is very deliquescent, and its solution when concen- 



TRI METHYL AMINE. 621 

trated has a caustic action on the skin and mucous membrane. It is 
free from odor, except when heated or mixed with an alkali, when the 
fishy smell is evolved. The taste of a solution of this salt is alkaline, 
but not disagreeable (Dujardin-Beaumetz). Dose, grs. ij to grs. v 
every three hours. 

Antagonists and Incompatibles. — Chemically trimethylamine is 
incompatible with the mineral acids, the salts of the metals, the alkalies 
(chlorides), and vegetable infusions. Tt should always be prescribed 
alone, in solution in some aromatic water. Therapeutically, it is an- 
tagonized by the stimulants, opium, belladonna, digitalis, etc. 

Synergists. — All agents depressing the vascular system and the 
temperature are synergistic. 

Physiological Actions. — Applied to the skin, mucous membrane, 
or areolar tissue, trimethylamine produces decided caustic effects, com- 
parable to those which result from the action of ammonia. It excites 
gastric pain when taken into the stomach in considerable doses, and 
will, doubtless, cause a high degree of inflammation if incautiously ad- 
ministered. The most characteristic effects are the lowering of the ac- 
tion of the heart, the depression of the temperature, and the diminution 
in the amount of urea excreted. In the physiological state Dujardin- 
Beaumetz found, in some experiments on himself, that the chloride of 
trimethylamine lessened the temperature and the pulse, but these re- 
sults were much more decided when it was administered in cases of 
acute rheumatism. The influence which this agent has on the excre- 
tion of urea is still more remarkable. The observations of Dujardin- 
Beaumetz show that a gradual but considerable decline in the excre- 
tion of urea is a constant result of its administration. On the other 
hand, Spencer says that the excretion of urea is sometimes increased, 
and, in one case in which the urinary discharge was carefully studied, 
the urine was almost trebled, and the urea more than doubled by the 
use of this remedy. If the diminution of the amount of urea were a 
constant result, as claimed by Dujardin-Beaumetz, the influence which 
trimethylamine has on the body temperature might be due to an in- 
terference with the combustion process. But the facts do not as yet 
justify the construction of a theory as to its mode of action. 

Therapy. — Thus far almost the only application made of trime- 
thylamine is in the treatment of acute rheumatism and gout. In some 
cases it appears to produce almost complete relief after the administra- 
tion of a few doses, but generally a longer time is required (Awenarius, 
Dujardin-Beaumetz, Spencer, Leo). It moderates, at once, the fever 
and the joint-pain, and very decidedly shortens the duration of the dis- 
ease. It is said to diminish the tendency to cardiac complication. 

This agent, having so decided an influence on the pulse, tempera- 
ture, and excretion of urea, will in the future doubtless be applied to 
the treatment of other maladies. 



622 MOTOR DEPRESSANTS. 

Authorities referred to : 

Buchheim, Dr. Erwin. Ueber das Trimethylamin. Schmidt's Jahrbucher, vol. lxxxiii, 
p. 13. 

Dujardin-Beaumetz, Dr. Du Chlorhydrate de TrimetJiylamine dans le Traitement 
du BJiumatisme Articidaire Aigu. Bulletin General de Tlierapeutique, vol. lxxxiv, pp. 
337, 395. 

Leo, Dr. Berliner kliniscJie WocJienscJirift, 1875. 

Petit, M. A. Sur la TrimetJiylamine. Bulletin General de Therapeutique, vol. lxxxiv, 
p. 313, et seq. 

Spencer, Dr. W. H. On the Employment of Trimethylamine in Rheumatism and 
Gout. The Practitioner, February and March, 1875. 

Pilocarpus. — Jaborandi. The leaflets of Pilocarpus pennatifolius 
Lemaire (Nat. Ord. Rutacece, Xanthoxyleas). 

Infusum Pilocarpi. — Infusion of pilocarpus ( § ij — Oj). Dose, § ss 
— 1 ij. (Not official.) 

Extracium Pilocarpi Fluidum, — Fluid extract of pilocarpus. 
Dose, 3 ss — 3 ij. 

Tinctura Pilocarpi. — Tincture of pilocarpus ( § iv — Oj). Dose, 
3 ss — 3 ij. (Not official.) 

Composition. — The important constituent is the alkaloid — pilocar- 
pine — which possesses the physiological properties of the drug. It 
combines with acids to form salts. The salts of pilocarpine crystallize 
in the oblique system. In 1880 another alkaloid was discovered, and 
to this the name jaborine was given (Harnack und Meyer). Subse- 
quent researches fully confirmed this (P. Castaing). These alkaloids 
are closely related in composition : probably identical, but having a 
different molecular arrangement. By heat, merely by concentration 
of an acid solution, pilocarpine is converted into jaborine (Hans Mey- 
er) ; and by washing with absolute alcohol they are separated, when 
united, as is very often the case in the commercial article. As these 
two alkaloids differ very greatly in properties, it is not surprising that 
the observations made with pilocarpine at first were very discrepant. 
Chemically they differ in that the salts of jaborine do not crystallize, 
and they dissolve more easily in ether and less easily in water. Physi- 
ologically, they differ even more decidedly. Jaborine acts like atro- 
pine, to which pilocarpine is a physiological antagonist. 

Pilocarpines Hydrochloras. — Hydrochlorate of pilocarpine. Mi- 
nute, white crystals, deliquescent, odorless, having a faintly bitter taste 
and a neutral reaction. Very soluble in water and in alcohol, but al- 
most insoluble in ether or chloroform. Dose, gr. y 1 ^ — gr. ss. 

Antagonists and Incompatibles. — The caustic alkalies, the per- 
salts of iron, and the salts of the metals generally, are chemically 
incompatible. A remarkable antagonism has been shown to exist 
between pilocarpine and belladonna (Ringer and Gould). 

Synergists. — Aconite, veratrum viride, gelsemium, and remedies 



PILOCARPUS. 623 

which paralyze the vaso-motor nervous system, promote the activity 
of jaborandi. 

Physiological Actions. — The taste of jaborandi is rather hot and 
pungent. The considerable doses of the crude drug required to pro- 
duce physiological effects excite nausea and vomiting, especially if 
taken on an empty stomach. It has been shown, however, in recent 
experiments, that these results follow the use of the alkaloid ; hence 
it may be concluded that not bulk alone is the cause of the gas- 
tric distress, but that it is one of the physiological properties of the 
drug. 

The active principles of jaborandi diffuse readily into the blood. 
In about ten minutes after the infusion is swallowed, the face, ears, 
and neck become deeply flushed. Simultaneously perspiration begins 
on the skin, an abundant flow of saliva takes place, the nasal and bron- 
chial mucus, and the tears, are increased, and watery diarrhoea may 
occur. It is said that, when the salivary secretion is greatly increased, 
that of the skin is relatively less so, and vice versa (Fereol), but this 
is not generally admitted. The quantity of perspiration poured out 
by the skin is enormous — the sweat runs from the body and soaks the 
clothes. The quantity of saliva discharged is also very great. Ringer 
reports that in two of his cases the amount of saliva was respectively 
twenty-two ounces and twenty-seven ounces. According to Petithau, 
the sialogogue effect is constant, the diaphoretic action is somewhat 
less certain, and the diuretic effect uncertain. These conclusions are 
in accord with the general experience. 

The action of the heart is increased by jaborandi, but the arterial 
tension is notably diminished. The rise in the pulse-rate averages 
twenty beats, and the duration of this effect is about two and a half 
hours. A very distinct fall of temperature (0'5° to 2° Fahr.) ensues 
when the sweating begins, and this decline of body-heat is maintained 
on an average about four and a half hours. According to Robin, Gil- 
let de Grandmont, and others, a transient rise of temperature precedes 
the fall, but Ringer and Riegel deny the accuracy of this observation. 
In some subjects, very serious symptoms due to the sudden develop- 
ment of extensive pulmonary oedema have been observed by Thomas, 
Napier, Sanger, Jenkins, and others. 

The nauseant effects of pilocarpus and its alkaloid are, it is prob- 
able, referable to the action which it exerts on the muscular layer of 
the stomach and intestines. Very active movements of these organs 
follow its administration, and even a tetanizing action is observed. 
Secretion of the mucous membrane is increased, due, doubtless, to 
stimulation of the pancreas and the glands of the mucous membrane 
(Harnack und Meyer, Morat). 

The effects of jaborandi on children, according to Ringer, are, 
singularly enough, much less, for corresponding doses, than on adults, 



624 MOTOR DEPRESSANTS. 

as respects the flushing, the sweating, the salivation, and the tem- 
perature. 

More or less drowsiness, both in children and adults, follows the 
profuse sweating, and pallor succeeds to the flushing. Chilliness is 
experienced with the cessation of the sweating stage. Languor and 
debility persist for some hours after the completion of the effects. 
The drowsiness is probably not due to a direct action of the remedy 
on the cerebrum, but to the greatly-diminished vascular tonus, and to 
the loss of fluid from the vessels. Vision is generally affected. The 
pupil is usually contracted, and the power of accommodation is im- 
paired. No characteristic or constant changes in the fundus of the 
eye have been observed on ophthalmoscopic examination. Locally ap- 
plied to the eye, jaborandi causes " contraction of the pupil, tension of 
the accommodative apparatus of the eye, with approximation to the 
nearest and farthest points of vision, and amblyopic impairment of 
vision from diminished sensibility of the retina." The eye resumes its 
normal state in about an hour and a half (Tweedy). 

The results of experiment indicate that the action of jaborandi is 
paralyzant of the vaso-motor nervous system. The flushing of the 
skin is doubtless due to dilatation of the arterioles, and the increased 
action of the heart must be referred to the same cause. The sphygmo- 
graph demonstrates the lowering of the vascular tension. The decline 
in temperature must be referred chiefly to the profuse transpiration, 
but the depression of the vascular tonus may also somewhat influence 
this result. The data do not yet exist for a statement of the mode in 
which jaborandi excites the salivary and cutaneous secretions. It 
probably affects the end-organs of the excito-secretory nerves (Har- 
nack und Meyer, Vulpian, Dujardin-Beaumetz, Grocco, and others). 

That pilocarpus stimulates the gravid uterus is affirmed by many 
observers. Vander Neg asserts that, when injected subcutaneously or 
into a vein, it promptly induces uterine contractions, or increases the 
energy of those already existing. Kleinwachter reports two cases in 
which it induced premature labor. Three injections of two centi- 
grammes each produced this result in one case, and two injections suf- 
ficed in the other. Dr. Prochownick, of Hamburg, also reports two 
cases of eclampsia, in which theliypodermatic injection of hydrochlorate 
of pilocarpine inaugurated labor in a half -hour. It frequently fails, 
even in considerable doses, to have this effect. Of nine reported in- 
stances in which it was used to induce premature labor, in six it was 
successful and in three it had no effect. The cases in which uterine 
action has been induced were chiefly eclampsia, and hence there is an 
important source of fallacy. 

Elimination of the active constituents of jaborandi probably takes 
place through the organs whose functions are so powerfully excited. 
It is a remarkable circumstance that the amount of urea passing out 



PILOCARPUS. 625 

in the sweat caused by jaborandi is enormously increased over the 
normal, amounting to from fifteen to seventeen grains. The urine is 
not increased, as a rule, but Gubler apparently demonstrated that small 
doses frequently repeated had a distinct diuretic action. His theory 
is based on the notion that, being a universal gland-stimulant, if the 
skin is not directly stimulated and the fluids directed to it, the kidneys 
will be acted on. In some instances the growth of hair has been pro- 
moted by the subcutaneous and topical application of pilocarpus (Pren- 
tiss, Andre, and others). 

The experiments which have demonstrated the existence of a physi- 
ological antagonism between jaborandi and belladonna have thrown 
much light on the action of the former. When the heart of a frog is 
arrested in the diastole by jaborandi, it immediately recommences its 
beat when atropine is subcutaneously injected (Langley). When the 
superior ganglion of the cervical sympathetic, and the lingual, and the 
pneumogastric nerve are divided, jaborandi administered causes pro- 
fuse salivary secretion ; but this action is at once antagonized and 
the secretion arrested by the injection of atropine. These agents, 
therefore, are exactly opposed as respects their action on the nerve- 
endings in the salivary glands (Carville). The effects of one grain of 
atropine, in a boy poisoned by it, were, as respects the state of the 
mouth and skin, antagonized by thirty grains of jaborandi. In three 
men the perspiration and salivation caused by sixty grains of jabo- 
randi were arrested by the subcutaneous injection of y^ of a grain of 
atropine (Ringer and Gould). 

Comparative Action of Pilocarpine and Jaborine. — The differ- 
ences in physiological action between these alkaloids are infinitely 
greater than the chemical. There does not exist a finer illustration of 
the importance of molecular arrangement to physiological action. 
Given two alkaloids having the same ultimate constituents, their actions 
become antagonistic by reason of an unknown molecular arrangement. 
Jaborine, in its effects on the heart, lungs, pupils, and salivary glands, 
is identical with atropine. In the whole range of physiological antag- 
onisms, there is none more complete than that existing between atro- 
pine and pilocarpine. As in some specimens of pilocarpine — owing, 
doubtless, to faulty pharmaceutical processes — there is more or less 
jaborine, it is no longer difficult to explain how some observers have 
differed in their observations. As the effect of pilocarpine on the cir- 
culation and the sweat-glands is so completely antagonized by jaborinej 
it is in a high degree important, in prescribing the former, to secure a 
specimen free from the latter. 

Therapy. — Pilocarpus, acting as it does on the salivary glands, has 

been used with varying success in mumps, sometimes succeeding well, 

and then failing. According to Testa, if used in time it may arrest 

the development of the disease, and later may prevent metastasis. 

41 






MOTOR DEPRESSANTS. 

In salivation of pregnancy ', it has succeeded in a few instances, but 
more frequently fails ; atropine is generally much more certain and 
effective. It is contraindicated in all affections of the gastrointes- 
tinal mucous membrane, and in weak heart due to disease of its mus- 
cular substance, or of its contained ganglia, or of the valves. It is a 
remedy of great value in cardiac dropsy, provided the contraindica- 
tions above mentioned do not exist ; its therapeutic power being 
much the same as the vapor, hot-air bath, and other means for pro- 
moting free diaphoresis. The effusions of recent pleuritis, hydro- 
thorax, and ascites, have been quickly removed by this agent. In 
asthma with profuse expectoration (humid asthma), and in bronchitis 
with abundant, non-purulent exudation, it has often been very bene- 
ficial. It must be used with caution, or not at all, in the difficult 
breathing due to dilatation of the right cavities and great venous 
trunks. According to Berkhart, pilocarpine, injected subcutaneously, 
arrests the most violent paroxysms of spasmodic asthma, and the re- 
lief persists for some time. It is equally effective, in the author's ex- 
perience, in singultus or hiccough, but there may be incurable lesions 
underlying the spasm, when, of course, the paroxysms may be expected 
to recur again. 

Probably the most conspicuous good results from the administra- 
tion of pilocarpine have been obtained in eclampsia, from the albumi- 
nuria of pregnancy, of scarlatina, or of acute Bright's disease. The 
powerful action on the sudoriparous glands, and the excretion of the 
urinary solids by the sweat, are the causes of the extraordinary relief 
obtained from this remedy in suitable cases. It should be borne in 
mind that pilocarpus tends to excite uterine action, and hence its ad- 
ministration may, under some circumstances, be improper ; but in most 
cases this effect is desired. There are, however, two important contra- 
indications : a weak heart, from thinning and atrophy of the walls of 
the organ, or from fatty degeneration, and a tendency to pulmonary 
congestion and oedema. In some instances, in a few minutes after the 
injection, the respiration became embarrassed by congestion and oedema 
of the lungs and by enormous bronchial secretion (Sanger, ^Napier, G. 
Thomas). It may be well to mention that atropine, subcutaneously, 
in one case in which it was administered, removed these symptoms and 
saved the patient's life. In renal dropsy, especially scarlatinal, there 
being no contraindication in the state of the heart, it is a remedy of 
the greatest utility. 

Pilocarpine has proved to be an important addition to the re- 
sources of the ophthalmologist. In inflammatory affections with effu- 
sion and exudation it brings about resolution and absorption (Wecker). 
According to Coursserant, there is no remedy comparable to it in 
the amblyopia of alcoholism and of tobacco -abuse. It has produced 
excellent results in detachment of the retina, chronic iritis, keratitis, 



PILOCARPUS. 627 

haemorrhages into the vitreous, floating bodies, glaucoma, atrophic 
choroiditis, haemorrhages and exudations of the retina, commencing 
atrophy of the optic nerves, etc. (Gillet de Grandmont, Meyer, Gub- 
ler, Wecker, and others). The first-named author affirms that we 
find in pilocarpine " an absolute remedy against white atrophy." Be- 
ranger, following Gubler, proposes to use this remedy as a substitute 
for eserine in certain ocular affections requiring a myositic — an effect 
produced by pilocarpine when instilled in the eye. It has been used 
successfully de novo and as a substitute for eserine in certain paralyses 
of the ocular muscles — those consecutive to the fevers and other acute 
diseases. After the operation for cataract extraction, pilocarpine is 
used by Chalot to prevent exudations and other inflammatory changes. 
In the discussion which ensued before the Geneva Congress where this 
paper was read, various adverse opinions were expressed regarding the 
exhibition of this remedy in different ocular maladies. Especially was 
the danger emphasized — the danger in cases of cardiac and arterial 
diseases, and of pulmonary engorgement. 

Ringer has used jaborandi with success to increase the secretion of 
milk. As the milk-glands correspond in structure to the sudoriparous 
glands, and are merely differentiated and specialized for their particu- 
lar office, the effects of this drug in increasing the production of milk 
might have been, a priori, expected. The author has used recently a 
fluid extract of jaborandi successfully in a case of deficiency in the 
secretion of the milk of a nursing-woman. But Dr. Max Strumpf 
denies that it has such power. 

In two cases of that very intractable disorder, diabetes insipidus, 
or polydipsia, Laycock has used jaborandi with the effect to reduce 
the quantity of urine in one case from three hundred ounces to one 
hundred and twenty ounces per diem, and, in the other, from one hun- 
dred and fifty-eight ounces to ninety-eight ounces per diem. M. Hu- 
chard reports the cure of a case of the same kind, and also one of 
glycosuria ; on the other hand, Yulpian declares it to be useless. Mur- 
rell has found it to be useful in some cases of the sweats of phthisis 
and of other nocturnal sweats, but yet far inferior to atropine and 
picrotoxin. 

In scaly skin eruptions, pilocarpus has good effects by maintaining 
a moist state of the skin. It is the most efficient remedy for alopecia 
which we possess. In the treatment of this affection pilocarpine may 
be injected subcutaneously, or the fluid extract can be applied locally. 
The following is a very successful topical application : r> Ext. pilo- 
carpi fl., § j ; tinct. cantharidis, f ss ; lin. saponis, 5 ijss. M. Sig. : The 
scalp must be well rubbed with this lotion daily. In prurigo Pick 
had success, but failed in psoriasis, and he also succeeded in two 
cases of pruritus senilis and in one of urticaria. In alopecia pity- 
rodes, he had good results in ten cases, but not in alopecia areata. 



623 MOTOR DEPRESSANTS. 

Pick administered one sixth of a grain three times a day by the 
stomach. 

Recently Guttmann has brought forward pilocarpine as a remedy 
for diphtheria. He reports having successfully treated eighty-one 
cases without a single death, but these extraordinary results have not 
been confirmed. Numerous observations have been published, but out 
of the mass of cases and reports we can select only some of the most 
important. Soon after Guttmann's paper appeared, confirmatory state- 
ments were published by Lax, and directly contradictory by Lashke- 
witz. The latter lost all his cases treated with pilocarpine. Pitschen 
and Dilewsky, on the other hand, succeeded in curing many which 
would otherwise, they think, have died. Archambault treated twenty- 
one cases according to Guttmann's plan, and of these twelve died, a 
result which he considers bad. In this country Jacobi was one of the 
first to make a trial of the new remedy, and he pronounced against its 
utility. Payraudeau, who has made an exhaustive study of the sub- 
ject, offers some conclusions which seem to the author eminently sound. 
The false membrane in inaccessible situations is softened and detached 
by the action of pilocarpine ; it does not effect the elimination of the 
diphtheritic poison by the sweat which it induces ; it is apt to cause 
nausea, vomiting, and diarrhoea, and may in this way greatly increase 
the danger of the case ; it is positively contraindicated when the car- 
diac muscle is weakened in any way. Although these positions are 
perfectly tenable, there are facts more favorable to the utility of pilo- 
carpine. They are well stated by Courtois : The results of the treat- 
ment of diphtheria by pilocarpine, without being so good as were at 
first supposed, are nevertheless worthy of careful consideration. Chil- 
dren of less than five years offer such slight resistance to the action 
of the morbific germs of diphtheria, that they are rarely cured. Those 
above this age, in which the mixed form of the disease is most fre- 
quent, are especially favorable subjects for this treatment. The false 
membrane is more thoroughly detached, and has less tendency to be 
reproduced, than by any other treatment. An experienced German 
physician of Philadelphia, Dr. Loling, assures me that he finds it 
highly useful when the condition of the heart does not contra-indi- 
cate. Having observed cases in the course of the treatment, I am able 
to confirm Dr. Loling's statements. All are now agreed that efficient 
support must be given the patient by food and alcohol during the pilo- 
carpine treatment ; that cases characterized by extreme depression of 
the vital powers, and by weakness of the heart, are unsuited for this 
remedy. 

Guttmann exhibited pilocarpine with hydrochloric acid and pepsin 
by the stomach, giving from -^ gr. to J- gr. 

This subject must not be closed without some observations on the 



PHYSOSTIGMA. 629 

remarkable aid afforded by pilocarpus in the removal of exudations, 
under treatment by the remedies most effective for this purpose — 
iodides and mercurials. Above, attention has been called to the use 
of pilocarpus in causing absorption of effusions in the pleural, perito- 
neal, and other serous cavities ; but in this application it is used con- 
jointly with iodine and mercury, chiefly to increase the rate at which 
the exudates liquefied by these sorbifacients are taken up and excreted. 
In cases of gummata, for example, the specific action of mercury or 
iodine is rendered effective by the timely and conjoint use of pilocar- 
pus, exhibited once or twice a day. When the inflammatory deposits 
in chronic pneumonia, or chronic pleuritis, or in other organs are 
sought to be removed, the persistent administration of mercury and 
iodine will accomplish far more if, during their administration, pilo- 
carpine is given after certain periods have elapsed — for example, after 
one week, and for three or four days in each succeeding week. The 
size of the dose, and the amount given each day, will be determined by 
the degree of the action. The author has found that a dose large 
enough to cause but little sweating and salivation suffices. 
Authorities referred to : 

Anderson, Prof. McCall. Glasgow Journal, 1880. 

Archambault, Dr. Revue de Therapeutique for 1881. 

Berkhart, Dr. British Medical Journal, June, 1880. 

Castaing, P. Revue de Pharm., 1881. 

Dujardin-Beaumetz, Dr. Bulletin General de TJierapeutique for 1881. 

Guttmann, Dr. Berliner klinische Wochenschrift, 1881. 

Harnack und Mayer. Archiv fur experimented Pathologie und Pharmacologic, vol. 
xii, p. 366. 

Huchard, Dr. Journal de Therapeutique and Bulletin General de Therapeutique for 
1880, 1881, and 1882. 

Isham, Dr. Medical News and American Journal of the Medical Sciences, 1881. 

Labbe, Dr. Bulletin de la Societe de Therapeutique, November 30, 1881. Ab- 
stract. 

Morat, Dr. M. Journal de Therapeutique and Lancet, 1881. 

Murrel, Dr. 

Prochownick, Dr. (de Hambourg). De VArt Medical for 1881. Quoted. 

Ringer and Gould, Drs. Pampblets. 

Vulpian, Prof. Dr. Journal de Therapeutique and Bulletin General de Therapeutique 
for 1881. 

Phy SO stigma. — Calabar bean. The seed of Physostigma veneno- 
sum Balfour (Nat. Ord. Leguminosce, Papilionacece). Feve de Cala- 
bar, Fr. ; Kalabarbohne, Ger. 

Extractum Physostigmatis. — Extract of physostigma. Dose, gr. -J 
— gr. ss— gr. j. 

Tinctura Physostigmatis. — Tincture of physostigma. Dose, Til v 
— nixx. 



630 MOTOR DEPRESSANTS. 

Composition. — Calabar bean contains two alkaloids, physostigmine 
or eserine and calabarine. These have been supposed to be the same, 
but they differ in important particulars. Physostigmine or eserine 
crystallizes in colorless, rhomboidal plates, and has a bitter taste ; it 
has strong basic properties, and combines with acids to form salts, 
which are freely soluble. These alkaloids do Dot agree in physiological 
action ; physostigmine paralyzes, whereas calabarine has a tetanizing 
action. 

PhysostigmincB Salicylas. — Salicylate of physostigmine. In col- 
orless, shining, acicular, or short columnar crystals, turning reddish 
on long exposure to light and air, odorless, having a bitter taste and 
a neutral reaction. Soluble in 130 parts of water, and in 12 parts of 
alcohol at 59° Fahr. Dose, gr. -^ — gr. -£$. 

Antagonists and Incompatibles. — The vegetable astringents, 
tannic acid, and the caustic alkalies, are chemically incompatible. As 
respects physiological actions, physostigma is antagonized in a limited 
part, but not in the whole of its actions, by atropine, and still more by 
chloral. Therapeutically, the tetanizing agents may be regarded as 
opposed to physostigma. 

Stneegists. — The paralyzers, or depressors of the motor nervous 
system, conium, gelsemium, nitrate of amyl, etc., act in harmony with 
physostigma, increasing its effects in the whole range of its physiologi- 
cal influence. 

Physiological Actions. — The preparations of physostigma are apt 
to excite nausea. Increased secretion of the gastro-intestinal mucous 
membrane, and increased peristalsis, follow their administration. The 
active principles quickly diffuse into the blood. Physostigma does not 
impair the respiratory function of the blood, but, after death, loose 
coagula are found, the globules have undergone changes of shape, and 
rectangular plates of hsemato-crystallin occur (Leven and Laborde). 
The action of the heart is affected by considerable toxic doses ; it is 
paralyzed in the diastole, and is flabby, but it contracts lazily on elec- 
tric stimulation. In less than lethal doses the action of the heart is 
slowed, and the arterial tension is, for a brief period,' lowered, but soon 
rises considerably above the normal. As these effects are not due to 
an action on the inhibitory apparatus, and follow when the heart is 
separated from the vaso-motor center by division of the spinal cord, it 
is probable that the action consists in a stimulation of the cardiac gan- 
glia, and a subsequent paralyzing action on the cardiac muscles. The 
same result may be due to a paralyzing action on the accelerator nerves 
of the heart (Kohler). The respiration is more powerfully affected 
than the circulation. When a lethal dose is administered the respira- 
tion becomes slower and shallower, and death ensues from arrest of 
the respiratory movements (asphyxia), the heart continuing in action 
for some time afterward. 



PHYSOSTIGMA. 631 

Physostigma does not affect the centers of conscious impressions, 
and consciousness is preserved until the oxygenation of the blood is 
so far interfered with that carbonic-acid narcosis supervenes. Giddi- 
ness, vertigo, and a sense of muscular weakness and fatigue, are pro- 
duced by considerable doses (Gubler). When a lethal dose is ad- 
ministered to an animal, its muscular system soon grows weak, and 
complete paralysis soon after ensues. The voluntary muscular sys- 
tem, however, before complete resolution occurs, is agitated by a 
succession of tremors — temporary tetanic contractions followed by 
entire relaxation. These muscular tremblings occur, but more feebly, 
after complete paralysis, and persist in a slight degree after death. 
The muscular contractility is not destroyed, not even impaired, by 
physostigma. 

The irritability of the motor nerves is affected, if at all, to a very 
slight extent, and the sensibility of the sensory nerves is rather height- 
ened. It follows from these facts that the paralyzing effect of phy- 
sostigma is due to a direct action on the spinal cord. 

As respects its effects on the eye, we find that it is eminently char- 
acteristic, and whether introduced directly into the eye, or taken 
into the stomach, or thrown under the skin, it contracts the pupil. 
This is a local and peripheral action, exactly corresponding, as to 
its seat, to the action of atropine. The end-organs of the sympa- 
thetic, or of the motor oculi, and it may be of both, are acted upon. 
By some it is held that the contraction of the pupil is due to a 
tetanic state of the circular fibers (Grtinhagen, Rogow); by others, 
to a paralysis of the dilator system (Fraser, Hirschmann). It were 
probably safer to accept the conclusion that the nerves innervat- 
ing both sets of fibers are acted on — the motor oculi stimulated 
(see case by T. Wharton Jones, "Practitioner," vol. iii), the sym- 
pathetic depressed — for we find that tetanic contraction of the mus- 
cular fiber of the intestine, followed by dilatation and a paretic 
state, can be experimentally produced by physostigma. The ap- 
paratus of accommodation is also affected ; myosis begins in ten to 
fifteen minutes after eserine is inserted. Direct galvanization of 
the iris, contracted by physostigma, causes it to dilate (Engelhardt, 
Hermann). 

Therapy. — The applications of physostigma to the treatment of 
disease are by no means so important as the elaborate study given 
to its physiological action, by various observers, would seem to 
indicate. 

In torpor of the muscular layer of the intestine, combined with 
deficient secretion of the mucous membrane, this agent is often very 
serviceable. In some subjects fifteen minims of the tincture or a 
half-grain of the extract, taken at bedtime, will procure a morning 
evacuation, but it frequently fails. "When the state to be relieved 



632 MOTOR DEPRESSANTS. 

is such as is indicated above, a combination of physostigma, bella- 
donna, and nux- vomica, is sometimes very effective : ^ Tinct. phy- 
sostigmatis, tinct. nncis vomica3, tinct. belladonnas, aa 3 ij. M. 
Sig. Thirty drops in water, morning and evening. I£ Extract, 
pliysostigmatis, ext. belladonnas, ext. nucis vomicae, aa gr. v. M. 
Ft. pil. no. x. Sig. : One pill at bed-hour. Physostigma (gr. \ — 
gr. ss of the extract) is a useful addition to a cathartic pill. £}, Ext. 
pliysostigmatis, resinas podophylli, aa grs. iij. M. Ft. pil. no. vj. 
Sig. : One pill at bed-hour. 

To the troublesome flatidence of women at the climacteric pe- 
riod, usually associated with a paretic state of the muscular layer 
of the bowel, very great relief is often afforded by the use of phy- 
sostigma. With the relief to the flatulence there usually follows 
relief to the morbid fancies, the headache and vertigo connected 
with it. 

The action of physostigma on the spinal cord, as a paralyzer, natu- 
rally suggested its use in tetanus. The evidence of its utility is dis- 
crepant. Moreover, tetanus, in many instances, manifests a tendency 
to spontaneous cure. It is difficult, therefore, to estimate the precise 
value of physostigma, but about one half of the cases treated with this 
agent recover — according to Watson, ten in eighteen ; according to 
Roemer, twenty in forty-seven cases. A larger measure of success 
might have been achieved, had sufficient attention been paid to the 
quality of the extract used and to the mode of administration. The 
following remarks by Dr. Fraser, in regard to the treatment of tetanus 
by Calabar bean, are of great importance : 

" I should myself feel inclined always to commence the treatment 
by subcutaneous injection, and to repeat such injection until the sys- 
tem is decidedly affected, and then to administer the remedy by the 
mouth in a dose three times as large as is found necessary by subcu- 
taneous injection. Such a plan might be quite safely followed in a 
child of even nine years. If the remedial effects continue to be pro- 
duced by administration by the mouth, it should be persevered with, 
for such administration has obvious advantages as far as the conven- 
ience of the practitioner is concerned. In the more severe cases, how- 
ever, I believe subcutaneous injection should be alone employed. 
The distress and increase of spasm caused by swallowing, or the im- 
possibility of introducing substances by the mouth, will render this 
necessary. I can not, also, too strongly urge that subcutaneous injec- 
tion should always be used when severe and continued spasms occur, 
when a fatal result is imminent from the exhaustion caused by pro- 
longed and frequent convulsions, and when apnoea threatens at once 
to close the tragic scene. By it we obtain the quickest and most pow- 
erful effect. 

"From the preceding remarks it can not be expected that any 






PHYSOSTIGMA. 633 

arbitrary rules of dosage can be laid down. For an adult one grain 
of the extract by the stomach, or one third of a grain by subcutane- 
ous injection, will generally be sufficient to commence with. This 
should be repeated in two hours, when its effects will usually have 
passed off, and the succeeding doses may be modified according to the 
experience that will be thus gained. . . . The great object is to pro- 
duce as quickly as possible, and then to maintain, the physiological 
effect of physostigma in diminishing reflex excitability. The doses 
must, therefore, be continued in increasing quantities until this physi- 
ological effect is produced, or until the sedative action of the drug on 
the circulation is carried to a dangerous extreme, or until constant 
nausea and vomiting compel us to desist." 

Influenced by theoretical considerations, physostigma has been 
prescribed in chorea and epilepsy, but the results have not been en- 
couraging. It is true, successful cases of chorea have been reported, 
but the influence of favorable hygienic surroundings and time is so 
great in uncomplicated chorea, that we may well doubt whether phy- 
sostigma has any real influence. Of twelve cases of epilepsy treated 
by this agent, six were improved, and in the other six a notable in- 
crease in the number of the epileptic paroxysms took place (Williams). 

In progressive paralysis of the insane, remarkable improvement 
has occurred under the use of physostigma in a few cases (Browne), 
but in others the results have been entirely negative (Williams). As 
in this melancholy disorder no remedies have hitherto been of any 
avail, it is a gratifying fact that in some cases Calabar bean has 
seemed to stay its progress. 

Since it has been shown that physostigma lessens the activity of 
the respiratory function, lowers the action of the heart, and depresses 
the temperature, it has been used in bronchitis, congestion of the lungs, 
and pneumonia, with a degree of success which warrants more ex- 
tended and systematic use. 

Besides the various applications in ophthalmic practice growing 
out of the myosis produced by physostigma, it has been used with 
success in certain paralytic and convulsive states of the ocular muscles. 
In a case of paralysis of the third nerve, with ptosis, double vision, 
and immobile pupil, Wharton Jones effected a cure by the instillation 
of physostigma into the eye, whence he concludes that the myosis 
caused by this agent is due to the stimulation of the third nerve. 
Galezowski recommends the instillation of physostigma into the eye 
in cases of suppuration of the cornea and in amblyopia. Eserine disks 
(of gelatin) have been successfully employed in tic. 

The experiments — thirty in number — of the British Medical Asso- 
ciation Committee, with regard to the antagonism between physo- 
stigma and strychnine, have led them to the following conclusion : 

" Although the symptoms produced by either substance were mod- 



634 MOTOR DEPRESSANTS. 

ified considerably by the action of the other, there was no instance 
of recovery from a fatal dose." 

The antagonism between atropine and physostigma, at least to a 
considerable extent, has been well established, especially by the labors 
of Fraser. In 18G4 Kleinwachter, influenced probably by the marked 
antagonism of the two agents on the pupil, employed physostigma 
with success in a case of poisoning by atropine. The British Asso- 
ciation Committee, however, conclude as the result of their investiga- 
tions that — " 1. Sulphate of atropine antagonizes to a slight extent 
the fatal action of extract of Calabar bean ; 2. The area of antago- 
nism is more limited than even Dr. Eraser has indicated in his paper 
on the subject. 

"Thirty-one experiments, performed by the committee with hy- 
drate of chloral and Calabar bean, have shown that — 

" 1. Hydrate of chloral modifies to a great extent the action of a 
fatal dose of extract of Calabar bean, mitigating symptoms and pro- 
longing life. 

" 2. Hydrate of chloral, in some cases, saves life from a fatal dose 
of Calabar bean. 

" 3. If hydrate of chloral be given before extract of Calabar bean, 
so that the animal is deeply under the influence of hydrate of chloral 
before it receives the extract of Calabar bean, the symptoms pro- 
duced by the latter are much modified, and life is saved from the ef- 
fects of what would otherwise be a fatal dose. 

" 4. Chloral hydrate is of little service as an antagonist to extract 
of Calabar bean, if given some time after the latter. If the symptoms 
of the action of Calabar bean be in full operation, it will not save life, 
however it may modify symptoms." 

Uses of Eserine. — This alkaloid represents the powers of the plant, 
and is the most eligible form for internal administration, and for local 
use in ophthalmic therapeutics. Merck, however, maintains that the 
salicylate of physostigmine is the best preparation of the alkaloids, 
and it has been made official. The dose for internal and hypodermatic 
use ranges from-^ to y 1 ^ of a grain. Gelatin disks of eserine are now 
most frequently employed for instillation into the eye, but a neu- 
tral solution of any of its salts is convenient for this purpose. It is 
now largely used to counteract the effects of atropine on the pupil ; in 
iritis, to break away or prevent the formation of adhesions ; in ulcer- 
ation and suppuration of the cornea ; after extraction of cataract, to 
prevent suppuration (YTecker) ; in the operation of iridectomy. The 
curative influence of eserine in these cases is due to its action in low- 
ering the intra-ocular tension, in diminishing the conjunctival secre- 
tions by contracting the blood-vessels, and in checking the migration 
of the white blood-corpuscles (Wecker). Eserine may be substituted 
for physostigma for all purposes, by the stomach or hypodermatically. 



TOBACCO. 635 

Authorities referred to : 

Arnstein und SuSTCHiNSKr. Schmidt's Jahrbucher der gesammten Medicin, Band 
cxlii, p. 286. 

Bennett Dr. J. Hughes. Report of the Committee of the British Medical Association 
to investigate the Antagonism of Medicines. British Medical Journal, January 23, 1875. 

Browne, Dr. J. Crichton. British Medical Journal, p. 60, January 10, 18*74. 

Fraser Dr. Thomas R. An Experimental Research on the Antagonism between the 
Actions of Physostigma and Atropia, Edinburgh, 1872. (1 am indebted to the courtesy of 
Dr. Fraser for a copy of this important memoir.) 

Galezowski, Dr. Xavier. Gazette des Hopitaux, 124, 1869. 

Grunhagen, Dr. VirchouPs Archiv, Band xxx, p. 521. 

Hermann, Prof. Dr. L. Lehrbuch der experimentellen Toxicologic, Berlin, 1874, p. 337. 

Jones, T. Wharton. The Practitioner, vol. iii, and vol. vii, p. 345. 

Kohler, Dr. H. Experimentelle Beitrage zur Kenntniss der Eerzwirkung des Calabar, 
etc. Archiv fur experimentelle Pathologie und Pharmacologic, 1873, p. 276. 

Laschkewich, Dr. Virchow's Archiv, vol. xxxv, p. 294. 

Laborde et Leven, MM. Gazette de Paris, 3, 6, 1870. 

Papi, Clementi. (Gaz. Lomb.) Schmidt's Jahrbucher, vol. cxlii, p. 2S6. 

Roemer, Dr. B. St. Louis Medical Journal, 1873, p. 367. 

Subbotin, Dr. Victor. Ext. sem. Physostigmatis venen. bei atonischem Zustande des 
Darmkanals. Archiv fur klin. Medicin, vi, 2, 3, p. 285, 1869. 

Watson, Dr. Eben. The Practitioner, vol. iii, p. 146, and Edinburgh Medical Jour- 
nal, May, 1867, p. 999. 

Tabacum. — Tobacco. Tabac, Fr. ; TabaJcbldtter, Ger. The com- 
mercial dried leaves of Nicotiana tabacum Linne (Nat. Ord. Solana- 
cece). 

Infusum Tabaci. — Infusion of tobacco ( 3 j — Oj). Dose, as an 
enema, § ss — 5 iv. (Not official.) 

Oleum Tabaci. — Oil of tobacco. (Not official.) 

JInguentum Tabaci. — Tobacco-ointment ( § ss — § viij). (Not offi- 
cial.) 

Vinum Tabaci. — Wine of tobacco ( § j — Oj). Dose, th, v — 3 ss. 
(Not official.) 

Composition. — Tobacco contains a powerful alkaloid — nicotine — 
in combination with malic acid. It is an oily, colorless liquid, strongly 
alkaline in reaction. Its taste is hot and acrid, and its odor disagree- 
able and peculiar. It is contained in the dried leaves, in the propor- 
tion of about five per cent. 

Tobacco also contains a peculiar camphor — nicotianine. 

Tobacco-leaves are rich in mineral constituents — potash, lime, ni- 
trates, and phosphates. The vapor of tobacco "contains numerous 
basic substances of the picolinic series, and cedes to caustic potash, 
hydrocyanic acid, sulphureted hydrogen, several volatile fatty acids, 
phenol, and creosote" (Fliickiger and Hanbury, Husemann). It does 
not contain nicotine. The oil of tobacco is an empyreumatic product, 
obtained by distillation. 

Antagonists and Incompatibles. — The caustic alkalies, tannin, 



C36 MOTOR DEPRESSANTS. 

and the iodides, are chemically incompatible. Strychnine is, accord- 
ing to Haughton, a true physiological antagonist. Ergot, digitalis, 
belladonna, ammonia, and alcoholic stimulants, antagonize the effects 
of tobacco on the heart and arterial system. 

In cases of poisoning, the stomach should be evacuated by emetics 
or the stomach-pump, and tannin and the iodides should be adminis- 
tered. Ammonia and brandy are indicated to relieve the failing cir- 
culation. Subcutaneous injection of strychnine should also be resorted 
to, and, if necessary, artificial respiration. 

Synergists. — All of the motor depressants increase the effects of 
tobacco. 

Physiological Effects. — Tobacco is a severe and very depress- 
ing nauseant and emetic. It is locally an irritant to the mucous mem- 
brane, and produces burning pain at the epigastrium. It is also laxa- 
tive even when smoked, and in considerable quantity by the stomach 
causes hypercatharsis. The emetic effect of tobacco is, doubtless, the 
product of three factors : its cerebral action, its local irritation of the 
gastric mucous membrane, and its specific emetic property. The secre- 
tions of the intestinal mucous membrane are increased, and the mus- 
cular layer is thrown into tetauic contraction, whence the catharsis 
which follows its administration. Applied to a wounded surface, 
tobacco produces the same effects. 

Its active principle, nicotine — the salts of which are crystalline — 
diffuses into the blood w T ith great rapidity. It corresponds, in the 
mode and intensity of its action, to prussic acid. In a case narrated 
by Taylor, a fatal result ensued in three minutes after a toxic dose. 
In another case death occurred in five minutes (M. Fougnies, poisoned 
by Count Bocarme). When a lethal dose is administered to an ani- 
mal, the action of the heart continues after respiration has ceased. 
Its cavities are usually found empty, or containing black fluid blood. 
Tobacco is not, therefore, a cardiac poison, and the depression of the 
circulation noted when full medicinal doses are administered is, doubt- 
less, due to the interference with the pulmonary functions. Applied 
directly to the muscular tissue of the heart, nicotine does not impair 
its contractile power (Benham). The blood throughout the body is 
black and fluid ; but, as agitation with oxygen restores its color, and 
as the blood-globules are unaffected, the condition of the blood is 
doubtless due to the arrest of oxygenation (asphyxia). 

Trembling and clonic spasms are produced by lethal doses of to- 
bacco. Its ultimate effect is paralyzing, but preceding the muscular 
relaxation and paresis there is in animals, and occasionally in man, a 
definite tetanic stage. Death ensues through its paralyzing action on 
the muscles of respiration. The end-organs of the motor nerves lose 
their excitability, next the trunks of the nerves, and then the spinal 
cord, but the muscular irritability is unaffected. The brain is not 



TOBACCO. 637 

directly affected. Giddiness and delirium have been noted in cases of 
poisoning by tobacco, but these symptoms, as well as the insensibility 
which immediately precedes death, are no doubt due to the accumu- 
lation of carbonic acid in the blood. The pupils are contracted by 
tobacco, and, in fatal cases, are insensible to light. 

There is considerable sweating, and the skin is cold and clammy in 
fatal cases. The temperature of the body is decidedly reduced (Tsches- 
chichin). The elimination of nicotine probably takes place by the kid- 
neys. Yery free urinary discharge, at all events, is produced by to- 
bacco, and, reasoning by analogy, it may be supposed that this effect 
is due to the direct action of the nicotine on the Marpighian tufts and 
on the tubules of the kidneys. 

When a lethal dose of nicotine has been taken, and the effects fol- 
low immediately, there may be none of the symptoms described above. 
In the case narrated by Taylor, the " deceased stared wildly ; there 
were no convulsions, and he died quietly [in three minutes], heaving a 
deep sigh in expiring." 

Therapy. — In habitual constipation, due to a relaxed state of the 
muscular layer of the bowel, five minims of the wine of tobacco, ad- 
ministered at bedtime, will not unfrequently afford relief. 

Impaction of the caicum, colica pictonum, sometimes intussuscep- 
tion, and strangulated hernia, may be overcome by a tobacco-enema. 
It must be borne in mind, however, that this is an expedient not free 
from danger. Numerous deaths have been caused by it, and Dr. Cope- 
land reports one instance in which thirty grains by enema proved fatal. 
Of the official infusion ( 3 j — Oj) it is not safe to use more than four 
ounces, or fifteen grains ; and this quantity may be expected to pro- 
duce most depressing nausea. It must be urged in favor of this remedy 
that it has, in very unfavorable cases, proved exceedingly effective. 
It is especially adapted to cases in which obstruction has occurred 
from paresis of the muscular layer of the bowel (impacted caecum, 
typhlitis, painter's colic). 

Tobacco is one of the antispasmodic remedies used in the treatment 
of spasmodic asthma, and the paroxysms of difficult breathing in em- 
physema. It enters as a constituent in various pastilles and cigarettes 
employed in these maladies. Asthmatics, unaccustomed to the use of 
tobacco, are sometimes relieved by smoking a cigar or pipe, but the 
effect is lost by habitual use. Laryngismus strididus may be quickly 
arrested by a snuff-plaster to the neck — an effective but dangerous 
domestic remedy. Obstinate hiccough, or singidtus, may be cured by 
five-minim doses of wine of tobacco, but we possess other useful reme- 
dies, less dangerous and less unpleasant in action. 

We possess no remedy more effective in the treatment of tetanus 
than tobacco. It may be used in the form of an enema, commencing 
with four ounces of the infusion, and regulating the quantity to be 



638 MOTOR DEPRESSANTS. 

administered and the time of administration by the effect produced. 
Minim-doses of the alkaloid may be given every two hours by the 
stomach, or two minims by the rectum (Haughton). When it acts 
favorably, it relaxes the trismus so that nutriment may be taken, and 
suspends the tonic convulsions. Care must be used not to introduce 
a lethal quantity, and produce death by asphyxia. The author has 
known the wine of tobacco to be used successfully in a severe case of 
tetanus, the quantity administered being regulated by the effect of the 
remedy on the convulsions. 

The experiments of Haughton having demonstrated an antagonism 
between nicotine and strychnine, he proposed the use of nicotine in 
strychnine-poisoning ', and cases have occurred in which it proved en- 
tirely successful. As the effects of nicotine are so nearly instantane- 
ous, the stomach administration — if the spasms do not prevent — will 
suffice, but rectal and even hypodermatic injections may be resorted 
to if necessary. The following formula of Erlenmeyer may be used 
for the subcutaneous injection in strychnine-poisoning and in tetanus : 
3 Mcotinaa, gr. ss ; aquae destil., 3 ij. M. Sig.: Ten minims contain 
-g^ of a grain. The cases of strychnine-poisoning in which tobacco 
was used successfully were treated by the infusion. 

Tobacco was formerly employed in the treatment of dropsy. It is 
adapted to those cases in which digitalis is now used. It promotes free 
diuresis, and is at the same time laxative — effects especially serviceable 
in cardiac dropsy. It is, however, so disagreeable in action that few 
practitioners have the temerity to prescribe it, and few patients are 
willing to swallow it. 

There is no doubt that excessive use of tobacco lessens the venereal 
appetite. Slightly nauseating doses of the wine of tobacco will check 
chordee and priapism. Satyriasis is effectively quenched in tobacco- 
nausea. Nocturnal pollutions, due to repletion and to continence, are 
also usually suspended by the use of this remedy ; but it is, unfor- 
tunately, so horribly depressing that the remedy may be justly con- 
sidered the greater evil. 

Local Uses of Tobacco. — So many unfortunate accidents have re- 
sulted from the external application of tobacco, that its use in this 
way is rarely justifiable. The infusion and an ointment have been 
employed with success in tinea, scabies, prurigo, pityriasis, etc. An 
injection of tobacco will destroy ascarides, but it is unsafe. Other 
and more manageable remedies have entirely taken the place of tobacco 
in the local diseases above named. 

Authorities referred to : 

Benham, Dr. TV*. T. On the Action of Nicotine. West Riding Lunatic Asylum Re- 
ports, vol. ir, p. 307. 

Blatin, M. le Dr. Rechcrches Phys. et Clin, sur la Nicotine et la Tabac. Gaz. des 
Hopitaux, 1870, p. 221. 



LOBELIA. 639 

Copland, Dr. Dictionary of Practical Medicine, article Colic, vol. i, p. 443. 

Curling, Mr. T. B. A Treatise on Tetanies, London, 1836. 

Erlenmeyer, Dr. A. Die subcutanen Injectionen der Arzneimittel, 3. Auflage, p. 85. 

Fluckiger and Hanbury. Pharmacographia, English edition, p. 418. 

Haughton, Ret. Prof. Dublin Hospital Gazette, December, 1856, and Dublin Quar- 
wrly Journal, August, 1862, p. 172. 

Hermann, Dr. L. Handbuch der exper. Toxicologic, p. 318. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzncimittellchre, zweiter Band, 
p. 1142. 

Hirschmann, Dr. Abstract in Bull. Gen. de Th'erap., lxv, p. 561. 

Hirt, Dr. Ludwig. Die Kranklieiten der Arbeiter, erster Theil, p. 156, et seq. 

Nasse, Dr. 0. Centralblatt fur die med. Wissensch., 1865, p. 785. 

Tardieu, A. Diet, d* Hygiene, deuxieme edition, 1862, article Tabac, p. 229, et seq. 

Taylor, Dr. A. S. On Poisons, third English edition, p. 803. 

Tscheschichin. Arch, fur Anatomie und Physiologic, 1866, p. 151. 

Traube, Dr. L. As quoted by Hermann. 

Uspensky, P. Arch, fur Anat. und Physiologie, 1868, p. 522. 

Van Praag, Dr. L. Arch fur Anat. und Physiologie, viii, p. 56. 

Von Basch und Oser. Wiener medicinische Jahrbucher, 1872, p. 387. 

Lobelia. — Lobelia. The leaves and tops of Lobelia inflata Linne 
(Nat. Ord. Lobeliacece), collected after a portion of the capsules 
have become inflated. Indian tobacco. Lobelie enfl'ee, Fr. ; Lobelia- 
kraut, Ger. 

Acetum Lobelia?. — Vinegar of lobelia. (Lobelia, ten parts — diluted 
acetic acid to make one hundred parts.) Dose, in v — 3 j. 

Tinctura Lobelice. — Tincture of lobelia. (Lobelia, twenty parts — 
diluted alcohol sufficient to make one hundred parts.) Dose, t\[ v — 3 j. 

Extractum Lobelias, Fluidum. — Fluid extract of lobelia. Dose, 

m j — 3 ss. 

Composition. — The effects of lobelia are due to the presence in it 
of a peculiar alkaloid — lobeline. This principle is oily in consistence, 
has a pungent, rather acrid taste, a tobacGO-like odor, and is strongly 
alkaline in reaction. It is slightly soluble in water, but more freely 
soluble in alcohol and ether. It combines with acids to form crystal- 
lizable salts, which are soluble in water and in alcohol. The active 
principle — lobeline — is combined in the plant with lobelie acid. 

Antagonists and Incohpatibles. — The caustic alkalies decom- 
pose lobeline ; hence these are incompatible. The depressing effects 
of lobelia on the circulation are counteracted by digitalis, belladonna, 
ergot, and other vaso-motor excitants, by alcohol, ether, ammonia, 
etc. ; on the nervous system of animal life, by strychnine, picrotoxin, 
thebaine, etc. 

Synergists. — All of the motor depressants increase the effects of 
lobelia. 

Physiological Actions. — The taste of lobelia is pungent and acrid, 
and it persists for a long time in the fauces. The leaves chewed excite 
a very abundant flow of saliva, and soon cause a feeling of epigastric 



640 MOTOR DEPRESSANTS. 

depression and nausea, with giddiness and headache. The preparations 
of lobelia administered by the stomach produce, in considerable doses, 
a degree of nausea and depression which amounts to anguish. An 
abundant outpouring of gastric mucus takes place, and vomiting en- 
sues, with great straining and distress. The action of the heart is 
enfeebled ; headache and vertigo are experienced ; a profuse sweat 
breaks out on the surface of the body ; the intestinal canal is relaxed, 
and the discharge of urine is increased. When a lethal dose is taken, 
especially if vomiting do not occur, the effects are chiefly expended on 
the nervous system of animal life. Muscular weakness and trembling, 
shallow respiration, coldness of the surface, feeble circulation, insensi- 
bility, and sometimes convulsions, have occurred. Death ensues from 
paralysis of the muscles of respiration — the action of the heart contin- 
uing after respiration has ceased. The insensibility is doubtless pro- 
duced in the same way as by tobacco, and the cerebral effects are not 
the result of a direct action of the poison. 

According to the investigations of Ott, lobeline, in moderate doses, 
first " increases the blood-pressure by acting as an excitant on the 
peripheral vaso-motor nervous system." This primary effect is not of 
long duration, a fall in the blood-pressure soon occurs, the peripheral 
circulation is so embarrassed from weakened power of the heart, and 
obstructed pulmonary circulation, that oxygenation of the tissues is 
rapidly impaired, and a marked reduction of temperature takes place. 
Lobeline affects chiefly the motor nervous system, and especially the 
medulla oblongata and its respiratory center (nucleus of pneumo- 
gastric). 

Therapy. — Lobelia is much employed by the self-styled pnysio- 
medical practitioners as a " sanative agent." The great quantity of 
mucus discharged from the stomach under its emetic action is consid- 
ered by them a proof of its power as an eliminating agent. As an 
emetic, lobelia is entirely too harsh and depressant to justify its use 
for this purpose. In habitual constipation, dependent on atony of the 
muscular layer of the bowel and deficient secretion of the mucous 
membrane, good results are sometimes obtained by small doses of the 
tincture — ten minims — administered at bedtime. Impaction of the 
caecum, when inflammation has not occurred, may be removed, and 
the bowels induced to act, by small doses, frequently repeated, of the 
tincture of lobelia (two drops every hour). This remedy can be used 
when purgatives would produce serious mischief. An infusion of lobe- 
lia as an enema has succeeded in relieving strangulated hernia, intus- 
susception, and fecal impactions. This use of the agent is the same as 
for the corresponding administration of tobacco ; it is much safer than 
tobacco, and can be made to produce as decided therapeutic effects. 

Unquestionably the most important application of lobelia is to the 
treatment of the asthmatic paroxysm. It gives relief in a few minutes 



HYDROCYANIC ACID. 641 

to violent attacks of spasmodic asthma, and it sometimes happens that 
the relief is permanent. Frequent repetition of this remedy in the 
same individual, however, lessens its effects, and, it may finally cease to 
afford any relief. To be effective in asthma, a teaspoonful dose of the 
acetum or tincture must be administered every fifteen minutes until 
nausea is induced. Free expectoration and abundant gaseous eructa- 
tions take place, and the breathing soon becomes easy and calm. The 
efficiency of lobelia is increased by the addition of iodide and bromide 
of ammonium. I£ Tinct. lobelia?, § j ; ammonii iodidi, 3 ij ; ammonii 
bromidi, 3 iij ; syrup, tolutaia., § ij. M. Sig. : A teaspoonful every 
one, two, three, or four hours. The hydrobromate of lobeline is the 
most efficient preparation for treating the respiratory neuroses, and 
certain cardiac affections, such as pseudo-angina pectoris. 

Whooping-cough, especially after the cessation of the catarrhal 
stage, has been treated successfully by lobelia, but we now possess 
other agents more offective and less disagreeable in action. Lobelia is, 
however, an excellent expectorant. It is adapted to cases in which the 
cough is dry, resonant, and spasmodic. It succeeds best in those who 
have attacks of cough with spasmodic difficulty of breathing, and 
who get up a little tough mucus after long and painful paroxysms of 
coughing. A lobelia-emetic will cut short an attack of spasmodic 
croup, but it; is too harsh and dangerous a remedy to be employed for 
this purpose ; but it is less dangerous than is generally supposed. 
In consequence of the fear which invests it, the doses given are often 
insufficient to effect the good results it may induce ; and this is true 
of the various catarrhal conditions of the respiratory mucous mem- 
brane especially. 

Authorities referred to : 

/ 

Ott, (Dr. J. Note on the Action of Lobelina on the Circulation. (Reprinted from the 
Boston J Medical and Surgical Journal.) 

For tcHER, Dr. Francis Peyre. Resources of the Southern Fields and Forests, p. 438. 

Acidum Hydrocyanicum. — Hydrocyanic or Prussic Acid. Acide 
hydrocyanique, Fr. ; Blausaure, Ger. 

/ Acidum Hydrocyanicum Dilutum. — Diluted hydrocyanic acid. A 
c/olorless liquid, having a peculiar odor, and wholly volatilized by heat. 
It imparts a faint, evanescent red color to litmus, and is not discol- 
ored by hydrosulphuric acid. With solution of nitrate of silver, added 
in slight excess, one hundred grains of it produce a white precipitate, 
which, when washed with water until the washings are tasteless, and 
dried at a temperature not exceeding 212°, weighs ten grains, and is 
wholly soluble in boiling nitric acid. 

The official diluted acid contains two per cent of anhydrous acid 
and ninety-eight per cent of alcohol and water. Dose, ill j — tti v. 

Antagonists and Incompatibles. — The metallic salts are gener- 
42 



642 MOTOR DEPRESSANTS. 

ally, incompatible ; also the red oxide of mercury and the sulphides. 
Freshly-precipitated oxide of iron (hydrated sesquioxide) has been 
proposed as a chemical antidote, but its action is too slow. In cases 
of poisoning, the remedies of the greatest utility are cold affusion 
to the spine, the inhalation of ammonia, the stomach administration, 
as also the intra-venous injection of this substance, and the subcutane- 
ous injection of ether. Atropine has been proposed as a physiological 
antagonist by Preyer ; but the rate at which atropine is diffused, as 
compared with the diffusion of prussic acid, obviously will render 
such antagonism powerless, how much soever it may be approved on 
theoretical grounds. The results of experiments, as the author and 
others have shown, are, however, opposed to the existence of this 
antagonism. In addition to these measures, artificial respiration 
should be practiced. 

Physiological Effects. — Applied to the unbroken skin, it is 
doubtful whether hydrocyanic acid is absorbed, but in contact with a 
wound or an abrasion, and with the mucous membrane, it diffuses into 
the blood with great rapidity. 

The vapor has a rather fragrant odor, similar to that of bitter al- 
monds. Inhaled, it has speedily caused death. When the effects of 
the vapor are short of lethal, giddiness, faintness, embarrassed breath- 
ing, a weak, small pulse, and great muscular weakness, are produced ; 
and there may be even coma and profound insensibility, and yet re- 
covery ensue (Taylor). 

In small medicinal doses, beyond a fugitive and very slight calma- 
tive effect, no symptoms are produced by it. When the dose some- 
what exceeds the medicinal standard, there may occur transient gid- 
diness, nausea, faintness, a feeble pulse, and general muscular weak- 
ness. The effects follow very speedily. When a very large toxic 
dose is taken, a few seconds only intervene from the act of swallowing 
until its effects are manifest, and death may ensue in two minutes or 
be postponed to five. Under these circumstances, the following phe- 
nomena have been observed : sudden insensibility ; eyes protruding 
and glistening ; pupils dilated and unaffected by light ; extremities 
cold, relaxed ; the skin covered with a clammy sweat ; breathing con- 
vulsive, slow ; the pulse extremely feeble or imperceptible ; evacua- 
tions involuntary (Taylor). When the effects are slower, in conse- 
quence of the ingestion of a merely lethal dose, there are occasionally 
tetanic convulsions, opisthotonos, trismus, etc. 

Although the effects of prussic acid are exceedingly rapid, a fatal 
result is not instantaneous. Various acts of volition may be gone 
through, provided but a few seconds are required for their perform- 
ance. Several instructive instances of this kind are narrated by Tay- 
lor. The effects of hydrocyanic acid are not more rapid than can be 
accounted for by its distribution through the blood. 



HYDROCYANIC ACID. 643 

Most contradictory opinions have been expressed as to the action 
of prussic acid on the blood : that it at first arterializes and afterward 
arrests decarbonization of the blood ; that it destroys the ozonizing 
power, and does not impair the capacity of the red blood-globules to 
carry and to yield up oxygen ; that cyanohaemoglobin is formed by 
the combination of the acid with haemoglobin, and that this combina- 
tion can not take place, owing to the rapidity of the action of the 
poison. From this chaotic state of scientific opinion the following 
may be evolved : the blood is dark, owing to deficient decarbonization, 
but this is probably due to a spasm of the pulmonary arterioles and 
paresis of the muscles of respiration, whence it follows that rapid as- 
phyxia ensues. The primary action of prussic acid on the terminal 
filaments of the pneumogastric, as shown by Preyer, is confirmatory 
of this view. 

Although the action of the heart ceases after respiration, prussic 
acid undoubtedly exerts a direct paralyzing action on the cardiac 
ganglia. 

The cerebral effects of this poison are, probably, indirect, the re- 
sult of rapid carbonic-acid poisoning, and the sudden withdrawal of 
oxygen from the cerebral tissues. Direct application of prussic acid 
to the medulla oblongata causes (in the alligator) a sudden and com- 
plete expiration, and collapse of the lung (Jones). The tetanic con- 
vulsions which have been observed in many cases of poisoning, in ani- 
mals and in man, indicate a direct action of this agent on the spasm- 
center ; but the disappearance of the excitability of the motor nerves, 
and of the contractility of muscles which it causes, shows that it 
quickly exhausts the irritability of the spinal cord. These effects on 
the cord, on the nerve-trunks, and on the muscles, are also, probably, 
in part due to the circulation through them of blood deprived of oxy- 
gen and charged with carbonic acid. The fact that instances of re- 
covery from a condition of profound insensibility are numerous, is con- 
firmatory of the view just expressed. Moreover, artificial respiration 
exerts an undeniable influence over the lethal effects of the acid in ani- 
mals (Preyer), whence it may be concluded that to supply oxygen to 
the blood is sufficient to arrest all of the symptoms produced by the 
want of oxygen and by the excess of carbonic acid. 

Post-mortem rigidity sets in early after death from prussic acid, 
and is very pronounced. The fingers are tightly closed, the toes 
strongly flexed, the jaws rigid, the eyes prominent and staring. The 
blood is dark-colored, fluid, and the venous trunks and the cerebral 
sinuses are gorged. 

The quantity of medicinal, diluted hydrocyanic acid necessary to 
produce death will vary with the age, size, and bodily vigor. Habit, 
also, influences to a remarkable degree the susceptibility to its toxic 
influence. A quantity equivalent to fortv minims of the diluted hy- 



QU MOTOR DEPRESSANTS. 

drocyanic acid (United States Pharmacopoeia) has proved fatal. As 
the effects of a medicinal dose are expended in a half hour to one hour, 
the repetition of the doses hourly will not be unsafe. Hydrocyanic 
acid is not a cumulative poison. 

Therapy. — Hydrocyanic acid is a remedy of very considerable util- 
ity in certain affections involving the functions of the pneumogastric 
nerve. It is often highly serviceable in various kinds of nervous vom- 
iting y for example, the vomiting of pregnancy, the vomiting which 
accompanies some cerebral disorders, and the reflex vomiting of phthi- 
sis. The good effects are quickly, if at all, produced ; hence, if no 
result is attained after some days' administration, no advantage can 
be expected from its continued administration. I£ Acid, hydrocyan. 
dil., 3 j ; aquae laur.-cerasi, | ij. M. Sig. : A teaspoonfid every two 
to four hours. 

Gastralgia, when it is a truly neuralgic affection of the gastric 
nerves, is occasionally very quickly cured by this agent. Sometimes 
cases, apparently in every way suitable for its use, are not improved 
by it. If a few doses do not effect any amelioration, it will be useless 
to continue it. Cases of indigestion accompanied by pain in the 
nucha, and attacks of giddiness (stomachal vertigo), are sometimes re- 
markably relieved by prussic acid. Irritative dyspepsia, manifested 
by these symptoms, a red-glazed tongue, pain, epigastric tenderness, 
and a feeling of weight and oppression, may be, not unfrequently, 
much benefited, and, indeed, cured ; but while the results are often 
brilliant, failures are also frequent. Enteralgia, a malady often ex- 
tremely rebellious to remedies, not unfrequently yields promptly to 
prussic acid. 

Considerable medicinal doses of this agent are very fatal to round 
worms (lumbricoides). 

Hydrocyanic acid is a successful remedy in ichooping -cough, after 
the subsidence of the catarrhal symptoms. It acts by allaying irrita- 
bility of the pneumogastric, and is successful just in proportion to the 
preponderance of the nervous symptoms. The cases in which the au- 
thor has witnessed the best results were cases of cough by habit, after 
the cessation of the whooping-cough proper. The nervous cough of 
mothers, which exists during the presence of whooping-cough in the 
household, may be allayed by this agent. !£ Acid, hydrocyan. dil., 
3 j ; tinct. sanguinariae, 3 iv ; syrp. senega?, 1 ss ; syrp. tolutan., 5 ij ; 
aquae lauro-cerasi, 3 vij. M. Sig. : One or two teaspoonfids, accord- 
ing to age, every three or four hours. For irritable cough. It some- 
times happens that this agent will greatly relieve the cough ofp>hthisis, 
but only when it is chiefly nervous. 

To allay cerebral irritation and excitement, prussic acid has been 
employed with benefit (McLeod). In forty cases of mental disorder ob- 
served by McLeod, there was "slight or temporary amelioration" in 



CYANIDE OF POTASSIUM. 645 

ten ; a " more decided and permanent effect," the disease being still sta- 
tionary or progressive, in nineteen ; and in eight cases, six of acute 
mania, and two of acute melancholia, " the drug has been a factor, and 
a very main one, in rapid restoration to reason." In the treatment of 
these cases, McLeod used from two to five minims of Scheele's dilute 
acid, which contains five per cent of anhydrous acid. His method of 
administration consisted in giving it at first at short intervals (every 
quarter of an hour), and, when effects were produced, every hour or 
two. He also employed it subcutaneously, in five-minim doses. 

External Uses. — In various cutaneous diseases characterized by 
itching, the local application of prussic acid affords relief. The follow- 
ing formula?, from Fox, represent serviceable combinations : fy Bi- 
chloride of mercury, gr. j ; dilute hydrocyanic acid, 3 j ; emulsion of 
almonds, § vj. M. Use in itching, in lichen, in the syphilodermata. 
J}, Dilute hydrocyanic acid, 3 ss to 3 j ; infusion of marsh-mallow, ^ v 
to 3 viij. M. Use in pruritus. Tjc Acetate of ammonia, | j ; dilute 
prussic acid, 3 jss ; infusion of tobacco, § viij. M. Sig. :- To be sponged 
on the part twice a day in pruritus ani or p. vulvm. ^ Borax, 3 j ; 
prussic acid, 3 ij ; rose-water, | viij. M. In the pruritus of old people. 

Authorities referred to : 

Amort, Dr. Robert. The Boston Medical and Surgical Journal, vol. ii, 1866, p. 73. 
Casper, von Dr. Carl Liman. Gericht. Medicin., zweiter Band, p. 521. 
Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic Blausaure, p. 288. 
Hoppe-Seyler. Archiv fur path. Anat., Band xxxviii, p. 435. 
Ibidem. Tubinger med. chern. Unter., p. 206. 
Husemann, Dr. Theod. Handbuch, etc., zweiter Band, p. 1136. 
Jones, Dr. Joseph. The Medical Record, New York, vol. ii, p. 459. 
Kolliker, Prop. Dr. Archiv fur path. Anat., Band x, p. 2*72. 

Lecorche et Meuriot, MM. Archives Generates de Med., tome xi, 6 ser., p. 530, 
et seq. 

McLeod, Dr. Kenneth. The Medical Times and Gazette, vol. i, 1863, p. 262. 
Preyer, Dr. W. Die Blausdure, phys. Untersucht, Bonn, 1868-"70. 
Taylor, Dr. A. S. On Poiso7is, third London edition, p. 585, et seq. 

Potassii Cyanidum. — Cyanide of Potassium. In white, opaque, 
amorphous pieces, having a sharp, somewhat alkaline and bitter-almond 
taste, and an alkaline reaction. It is deliquescent in moist air, readily 
soluble in water when reduced to powder, and sparingly soluble in alco- 
hol. Dose, gr. ^— gr. \. 

Antagonists and Incompatibles. — Acids decompose it and set 
free hydrocyanic acid. As respects its physiological properties, its an- 
tagonists are the same as those of hydrocyanic acid. 

Synergists. — Same as for hydrocyanic acid. 

Physiological Actions. — The effects of this salt have been already 
mentioned in sufficient detail in the preceding article, so far as they 
correspond to hydrocyanic acid. It has, however, some special physical 



646 MOTOR DEPRESSANTS. 

properties which separate it slightly from the powerful agent which en- 
ters into its composition. 

Applied to the unbroken epidermis, the cyanide of potassium 
produces at first a sensation of coldness, followed by tingling and 
itching, and in a half-hour the skin is found to be somewhat red- 
dened. Prolonged contact produces a phlyctenular or eczematous 
eruption. 

Systemic effects are produced by the local and external use of the 
cyanide of potassium, viz., slowing of the pulse and respiration, mus- 
cular weakness, drowsiness, and coldness. Lethal effects may follow 
prolonged contact with the skin, even when the epidermis is unbroken. 
Applied to a wound or abraded surface, this salt causes a burning pain, 
excites a high degree of inflammation, and produces prompt lethal 
effects. 

Theeapy. — Cyanide of potassium may be prescribed as a substitute 
for hydrocyanic acid in all of the maladies for which the latter is used. 
This salt has, however, some special applications which we owe to 
Trousseau. This eminent observer has shown that a solution of the 
cyanide applied to the seat of painful sensations gives great relief in 
various forms of reflex headache, gastric, cardiac, pulmonary, and men- 
strual. The headache which accompanies the pyretic state is, accord- 
ing to the same authority, cured or greatly alleviated by the cyanide 
solution, while at the same time a favorable influence is exerted over 
the temperature. 3 Potassii cyanidi, gr. x — 3j ; aquae lauro-cerasi, 
§ iv. M. Sig. : A compress, moistened with the solution, to be applied 
to the seat of pain. From a quarter to a half hour of contact with the 
skin usually suffices. 

A solution of the cyanide of potassium, of the strength given above, 
will remove the stains of nitrate of silver, and also the dissecting-room 
odor, from the hands. 

Cyanide of potassium, in the form of ointment or solution, is an ex- 
cellent remedy for allaying irritation in various cutaneous diseases. In 
pruritus and urticaria, the following formula (McCall Anderson) gives 
relief : ^ Potassii cyanidi, gr. vj ; pulv. cocci, gr. j ; ung. aq. rosae, 
| j. M. Sig.: Ointment. In eczema with pruritus, the same authori- 
ty recommends the following : I£ Potassii cyanidi, gr. v ; sulphuris, 
potassii bicarb., aa 3 ss ; pulv. cocci, gr. vj ; axungiae, § j. M. Sig. : 
Ointment. A solution of the cyanide of potassium is one of the most 
effective applications for that very troublesome disorder, pruritus pu- 
dendi. ^ Potassii cyanidi, gr. xv ; aquae lauro-cerasi, f viij. M. 
Sig. : Lotion. This formula is also serviceable in lichen and prurigo 
(Hardy). 

Entomologists make use of the cyanide to destroy insects without 
injuring their structures. One part of the cyanide, two parts of plas- 
ter of Paris, and one and a half part of water, made into a paste and 



NITRITE OF AMYL. 647 

poured into a wide-mouthed bottle, sets into a solid mass, which gives 
off the vapor of hydrocyanic acid (Squire). 

Authorities referred to : 

Trousseau et Pidoux. Trait'e de Therapeutique, etc., vol. ii, p. 265, el seq. 
Trousseau, A. Clinique Medicale, vol. ii, p. 332. 

Amyl Nitris. — Nitrite of amyl. Nitrite d'amyle, Fr. ; Amylni- 
trit, Ger. 

Properties. — A yellowish or reddish-yellow liquid, rather oily in 
consistence, very volatile, and having a peculiar and very diffusive 
ethereal odor. It is insoluble in water, but soluble in all proportions 
in alcohol, ether, chloroform, benzol and benzin. It has a neutral or 
a slightly acid reaction. It may contain, as impurities, nitric acid, amyl- 
nitric ether, amylvalerianic ether, and hydrocyanic acid. The specific 
gravity is # 8TT. Dose, tti ij — v\ v, by inhalation or subcutaneously. 

Antagonists. — The actions of the nitrite of amyl are antagonized 
by all those agents which increase the functional activity of the spinal 
cord and sympathetic — as strychnine, brucine, picrotoxin, digitalis, 
ergot, belladonna, and, as McCullough has shown, it is an efficient 
remedy in chloral - poisoning. The opposing action of amyl nitrite 
and ergot has been demonstrated clinically by Dr. Fancourt Barnes, 
in cases of hour-glass contraction induced by ergot. This antago- 
nism may not be available, owing to the difference in the rate at which 
they are diffused, to affect the system. 

Synergists. — All of the motor depressants increase the . effects of 
the nitrite of amyl. 

Physiological Actions. — The following are the symptoms pro- 
duced by nitrite of amyl when inhaled : acceleration of the action of 
the heart ; sudden flushing of the face ; dilatation of the arterioles in 
consequence of paresis of the muscular layer of these vessels ; a 
sense of extreme fullness of the brain, with vertigo ; fall in the blood- 
pressure ; lowering of the temperature ; complete resolution of the 
muscular system of animal life. The vapor of nitrite of amyl ap- 
plied directly to the tissues — muscular or nervous — suspends or com- 
pletely arrests functional activity. Circulating in the blood, it un- 
doubtedly affects most the vaso-motor nervous system and unstriped 
muscular fiber. 

The marked acceleration of the heart (Pick) is in part consecutive, 
doubtless, to the sudden dilatation of the arterioles, permitting such 
an increased quantity of the blood to enter these vessels as to require 
renewed effort on the part of the heart to supply it ; in part also to 
the paretic state which it induces in the inhibitory apparatus. The 
great fall in the blood-pressure noted by Brunton, Wood, and Amez- 
Droz, is also due to dilatation of the arterioles, and consequent dimi- 



643 MOTOR DEPRESSANTS. 

nution of tension in the peripheral vascular system. Dilatation of 
the retinal vessels, when nitrite of amyl is inhaled, has been ascer- 
tained by ophthalmoscopic examination (Aldridge). 

On the nervous system of animal life the nitrite of amyl acts as a 
depressant — impairing motility first, and, at the last, sensibility. It 
affects both the spinal cord and the nerves, lessening the sensibility 
to all forms of irritation, and diminishing the reflex functions. It also 
impairs the contractility of muscle. Death ensues from failure of res- 
piration, and the cerebral functions are unaffected until carbonic-acid 
poisoning ensues. 

Decided lowering of temperature is produced by the nitrite of 
amyl. This result is no doubt due to the action of this agent on the 
haemoglobin, whereby the carrying capacity of the red blood-glob- 
ules of oxygen is lessened (Gamgee), metamorphosis of tissue is in- 
terfered with, and the generation of animal heat is diminished. A 
peculiar change ensues in the color of the blood as a result of the 
lessened oxygenation : all the blood of the body assumes a modified 
venous hue. 

A curious fact has been noted by Hoffmann, viz. : the hypoder- 
matic injection of lethal doses of nitrite of amyl produces in rabbits a 
temporary glycosuria. 

Therapy. — The applications of the nitrite of amyl in the treat- 
ment of disease have been deduced from a study of its physiological 
actions. It is especially indicated when morbid symptoms result 
from vaso-motor spasm. It has been shown that epileptic attacks 
may be warded off by the inhalation of nitrite of amyl at the begin- 
ning of the movement of the aura. Patients who have a distinct 
warning of the seizures should be constantly provided with a small 
quantity of this remedy in order to practice the inhalation whenever 
an attack is impending. The mechanism of the action is very simple : 
the vaso-motor spasm of the cerebral vessels, which is the initial 
symptom of an epileptic convulsion, is relaxed, and the vessels dilated 
by the nitrite of amyl. 

By the timely inhalation of the nitrite, the cold stage of an ague 
may be aborted, but the hot stage is not modified in any way (Price, 
Ziegler). This power may be most serviceable in cases of pernicious 
intermittent, the danger of which consists in the extreme depression 
of the cold stage. The cardiac failure caused by chloral, chloroform, 
and other heart-poison, and the condition of sudden weakness which 
may ensue from various causes, in cases of fatty heart, are often re- 
markably relieved by the inhalation or hypodermatic injection of amyl 
nitrite. 

An attack of migraine, of that form characterized by vaso-motor 
spasm (pallor of the face), may be quickly relieved and sometimes 
aborted by the inhalation of two or three drops of amyl nitrite. 



NITRITE OF AMYL. 649 

When there are redness of the face, injection of the conjunctivae, and 
fullness of the cerebral vessels, this remedy is contraindicated. 
Cases of neuralgia of the fifth nerve, second division, have been 
cured by inhalation of amy], repeated from time to time as the pain 
required its administration. 

Asthma, when purely spasmodic, is usually quickly checked by 
this remedy. The paroxysms of difficult breathing which accompany 
emphysema and cardiac disease are not relieved in this way ; indeed, 
the author has known the most serious distress to be produced by the 
inhalation under these circumstances. 

Exaltation of the reflex function of the spinal cord and muscular 
spasm are morbid states in which good results may be expected from 
inhalation of the nitrite of amyl. It has been used with success in 
tetanus. It should also be fairly tried in strychnine-poisoning and in 
hydrophobia. Michael has administered it in tinnitus aurium, a most 
obstinate and distressing condition, with comparatively good effects : 
of a group of thirty-three cases, nineteen were distinctly benefited. 

Most signal relief has been obtained from the inhalation of amyl 
nitrite in angina pectoris. We owe this important suggestion and 
practice to Brunton, who had ascertained that when the paroxysm of 
angina pectoris occurs, a great rise of arterial tension takes place. 
When the pain, precordial distress, and anxiety are felt, there should 
be no delay in the use of the remedy. Some cautions are, however, 
needed. It may be unsafe when advanced degeneration of the cere- 
bral vessels exists (Anstie). Fatty degeneration of the heart, which 
is so frequently a cause or an accompaniment of angina pectoris, may 
also render the use of so powerful a paralyzer of doubtful expediency. 

Dr. Mary Putnam Jacobi has found the inhalation of nitrite of 
amyl very serviceable in neuralgic dysmenorrhoea. As an antagonist 
to ergot, it may prove in a high degree useful, when ill effects are 
caused by this remedy. Thus, in a case of hour-glass contraction pro- 
duced by ergot, the inhalation of amyl nitrite procured immediate re- 
lief. On theoretical grounds this agent was proposed for the relief of 
cholera asphyxia (Brunton, Gamgee), but the trials thus far made 
with it have demonstrated its inutility. Owing to the fact, shown by 
Gamgee, that nitrite of amyl combines with haemoglobin, Brunton pro- 
poses that this remedy, if given at all in cholera, must be administered 
by the stomach or by subcutaneous injection, and not by inhalation. 

Repetition in the use of the nitrite of amyl diminishes its effects, 
and hence increasing doses are necessary when it is often employed in 
the same case. 

Authorities referred to : 

Aldridge, Dr. Charles. The West Riding Lunatic Asylum Medical Reports, vol. i, 
p. 97. 

Amez-Droz, Dr. Archives de Physiologie Normale et Pathologique, ISIS, p. 467. 



650 MOTOR DEPRESSANTS. 

Anstie, Dk. F. E. Transactions of Clinical Society. Lancet, March 5, 1870. 
Brunton, Dr. T. L. The British Medical Journal, July 13, 1872. Ibid. The Lan- 
cet, July 27, 1867. 

Gamgee, Dr. Arthur. Philosophical Transactions, 1868, p. 589. 

Haddon, Dr. Johx. Edinburgh Medical Journal, July, 1870, p. 45. 

Jacobi, Dr. Mary Putnam. The Medical Record, New York, January 15, 1875. 

Mitchell, Dr. S. AVeir. The Philadelphia Medical Times, vol. v, p. 553. 

Wood, Dr. H. C. American Journal of the Medical Sciences, July, 1871. 

Nitro-Glycerinum.— Nitroglycerin. Teinitein. (Not official.) 

Properties. — Nitro-glycerin is an oily liquid, colorless, or pale yel- 
low, and has the specific gravity 1*60 at 59° Fahr. It burns quietly in 
the open air, but heated in a close vessel, or subjected to percussion, 
it explodes violently. It decomposes if long kept. It is very slightly 
soluble in water, but dissolves freely in alcohol and in ether. The 
best preparation for administration is the alcoholic solution — one part 
of nitro-glycerin to one hundred parts of alcohol. The dose of this 
ranges from one minim to many minims. As the susceptibility to this 
agent varies greatly, the initial dose should be the smallest. One 
minim of the one-per-cent solution will give some persons violent 
headache, while others may take a minim of the undiluted drug with- 
out any decided effect. 

It should not be forgotten that the alcoholic solution will explode 
if struck with a wet hammer. So much apprehension is felt by pa- 
tients who have to take this remedy, that the name trinitrin has been 
proposed for it, and has now come into general use. 

JSodii Nitris. — Nitrite of soda. 

Potassii JVitris. — Nitrite of potassium. These salts have been pro- 
posed and used as substitutes for amyl nitrite and nitro-glycerin. 
Dose, gr. iij — gr. viij. 

Antagonists. — All those agents which increase the reflex activity 
of the spinal cord and stimulate the vaso-motor system, as strychnine, 
ergot, digitalis, belladonna, etc., antagonize nitro-glycerin. 

Synergists. — Amyl nitrite acts very similarly, and the motor de- 
pressants in general promote the actions of nitro-glycerin. 

Physiological Actions. — The taste of nitro-glycerin is at first 
sweetish, but this impression is followed by aromatic pungency. In a 
few minutes — from three to five — after a small medicinal dose, there 
are suddenly experienced a feeling of giddiness, tension of the head, 
with fullness, languor, nausea, and sometimes stomach-pain. Such 
effects are experienced from a small dose, if the individual taking it 
is susceptible. It follows, then, that the quantity of nitro-glycerin 
causing such symptoms must vary in different patients. Dr. Harley 
experienced these effects after taking fifteen drops. Dr. Fuller expe- 
rienced some fullness of the head, perspiration, intermittent pulse, and 
some after-headache, from a dose equivalent to fifty minims of a one- 



NITRO-GLYCERIN. G51 

per-cent solution, or a half-drop of the nitro-glycerin itself (Murrell). 
In some persons a drop or two of the one-per-cent solution will cause 
dizziness, faintness, a rapid and very weak pulse, perspiration of a 
rather clammy character ; or, indeed, the symptoms may proceed to 
unconsciousness. Dr. Murrell applied the moistened cork of the bottle 
containing the solution to his lips, and in a few minutes experienced a 
tremendous action of the heart and arterial system ; his pulse rose to 
100 and higher, and he had " a splitting headache " for some time. 
There is no change in the temperature. Women and the feeble in 
constitution suffer more decided effects than the robust. Drowsiness 
comes on, with a feeling of languor, in those on whom the smallest 
dose acts kindly. With the rapid pulse is a considerable degree of 
dicrotism. The change in the character of the pulse begins in about 
six minutes after the dose is taken, and lasts on the whole about one 
hour. The sphygmographic tracings appended to Dr. Murrell's paper 
are remarkable for the extent of the excursions of the lever, the ab- 
rupt ascent, the sharpness of the summit, and the dicrotic rebound, in- 
dicating an extremely low state of the arterial tension. When the 
heart of a frog is put into a '75-per-cent salt solution, and two drops 
of a ten-per-cent solution of nitro-glycerin are added, the heart acts 
more and more slowly, and presently stops. An alcoholic solution 
has no effect (Brunton). When injected into the jugular vein of a 
cat, the nitro-glycerin solution arrests the heart speedily. That the 
vagus is paralyzed, and the inhibition thus removed from the heart, is 
proved by the fact that galvanic excitation of the vagus has no effect 
in restraining the cardiac movements. Changes occur in the blood 
like those induced by amyl nitrite and the nitrites of soda and other 
nitrites ; that is, the blood assumes a chocolate-color, and probably 
loses its power of absorbing and conveying oxygen ; but its so-called 
ozonizing function may not be interfered with, since nitro-glycerin 
does not prevent the guaiac reaction, in which respect it agrees with 
the other nitrites. The change in the color of the blood is produced 
slowly when blood is shaken up with some nitro-glycerin outside of 
the body (Brunton). 

In frogs nitro-glycerin causes weakness, tetanus, ending in paral- 
ysis ; but, in warm-blooded animals, there are convulsive movements, 
as twitching of the muscles, hiccough, spasmodic breathing, etc. The 
tetanus in frogs, according to Brunton, is not due to a direct action of 
the poison on the spinal cord, thus opposing the assumption of Minor, 
who held that it acts on the medulla. The paralyzing effect of nitro- 
glycerin appears to be due to an action on the muscles, and also on 
the motor nerves. When it is applied directly to the muscles, they 
quickly lose their contractility. The reflex function of the cord is 
extinguished first in the parts external to the cranium, the cerebral 
nerves preserving their power to transmit impressions until later. Sen- 



652 MOTOR DEPRESSANTS. 

sation is destroyed by it as well as motility. Death is due to asphyxia 
— to paralysis of the muscles of respiration. Notwithstanding the 
activity of nitro-glycerin, the most serious symptoms are recovered 
from without detriment. Thus Dr. Murrell narrates several cases in 
which unconsciousness was produced without any ill results, except 
some temporary headache. 

Therapy. — Nitro-glycerin is adapted to the treatment of the mala- 
dies in which its congener, amyl nitrite, has proved so effective. It 
has the advantages over the latter of being more permanent, more 
readily administered, and more sustained in action. In sea-sickness, 
reflex vomiting, gastralgia, hepatic colic, and other painful and spas- 
modic affections of the digestive tube, it may afford very prompt re- 
lief. It was first employed in the treatment of angina pectoris, in 
which it gives as much relief as does amyl nitrite, but the latter should 
be preferred when the utmost promptitude of action is necessary. The 
form of the disease requiring this medicine is that characterized by 
high tension of the peripheral vessels, which is doubtless the condition 
in the genuine cases of angina pectoris. Very prompt relief may be 
given to attacks of hiccough by this medicine. Some cases of spas- 
modic asthma are much benefited by it. The less there is of struc- 
tural alterations, the more certain the relief. As the secretions of the 
mucous membrane of the respiratory tract are increased by it, the 
cases with deficient secretion are those most certain to be benefited. 
It should be carefully tried in whooping-cough and in laryngismus 
stridulus. There is much to be expected from nitro-glycerin in dis- 
eases of the nervous system characterized by heightened reflexes. An 
attack of epilepsy may be aborted by its timely administration, and 
Hammond finds it as a remedy for this disease second only to the bro- 
mides. By preventing the spasm of the vessels and consequent sud- 
den anaemia of the brain, the first and most important event in the 
series can not occur. It should be fairly tried in tetanus and hydro- 
phobia. In neuralgia of the fifth nerve it has given immediate relief 
in numerous instances. It is the most appropriate remedy in that form 
of migraine, or sick-headache, in which the vessels are in a condition 
of spasm, but is not proper in those cases having a flushed face from 
dilated vessels. 

The cold stage of an intermittent may be aborted by the timely 
administration of nitro-glycerin. It promises to be especially useful 
in the pernicious malarial diseases to prevent the dangerous depression 
of the cold stage. In these cases its administration should be so timed 
that the physiological effect of the remedy occur at the onset of the 
cold stage of the disease. The mechanism of its curative action is 
obvious. Remarkable results have lately been obtained from this 
remedy in acute and chronic BrigMs disease (Robson) — results which 
the author is able, from personal observations, to confirm. It is well 



ACONITE. 653 

known, of course, that high arterial tension is present ; but whether 
as causative of the renal changes, or a consequence of them, is not 
known. The apparently constant association of degenerative changes 
in the renal ganglia with the lesions of Bright's disease, discovered by 
Da Costa and Longstreth, would indicate that the state of the vessels 
is a factor in developing the structural alterations. The manner in 
which nitro-glycerin affords relief, and possibly effects a cure, is thus 
fully explained. Indeed, all of the curative results obtained from 
nitro-glycerin must be referred to its action on the vascular apparatus. 
The suggestions as to its therapeutical employment above made 
have been abundantly justified by the experiences gained since the 
publication of the last edition of this work. The author has now to 
submit some observations on the utility of trinitrin in cardiac affec- 
tions. Pseudo-angina pectoris, fatty heart, and weak heart, are mor- 
bid states that appear from about forty-five onward. Degenerative 
changes, belonging to advanced life, underlie the attacks of pain with 
disordered function, and are also responsible, to some extent, for the 
other condition. Weak cardiac contractions, and damaged vessels, 
interfere with the nutrition of the body in general, including the mus- 
cular substance of the heart. Feebleness of the cardiac contractions 
lessens the force of the impulsion with which the blood enters the arte- 
rioles, and they contract on their lumen as the anaemia increases. Now, 
trinitrin opposes this state of things. Under its action, the heart con- 
tracts more frequently and energetically, the arterioles dilate, and 
thus the organs of circulation are helped in two modes : in facilitating 
the distribution of the blood by lessening the pressure in the arterioles 
at the periphery ; and in improving the power of its own muscular tis- 
sue, by the increased amount of blood passing into it through the 
coronary artery. If we add to these good effects the permanent im- 
provement of nutrition by a suitable diet and exercise, we have a sat- 
isfactory solution of some of the most difficult problems given us to 
solve. It should be understood, also, that the improvement of nutri- 
tion by increased alimentation is the more complete because, by the 
action of trinitrin, a much larger quantity of blood is obtained by the 
tissues, and hence more of the nutritious matters, than would other- 
wise be available. The author has availed himself of these facts, and 
has utilized trinitrin in the treatment of anwmia in its ordinary form, 
and in the pernicious variety. One of the most common of the thera- 
peutical fallacies of the day is the giving of iron to cure anaemia, for 
in a large proportion of the cases the iron can not be assimilated. The 
organs concerned in blood-making may be in a pathological condition, 
or functionally torpid. Stomachal and intestinal digestion may be in 
such a state that the ordinary preparation of food-stuffs is too imper- 
fectly performed for the materials to be utilized in blood-making. To 
cure anaemia, something more is requisite than to give iron. The 



654 MOTOR DEPRESSANTS. 

functional or pathological states that interfere must be removed. 
When all the digestive and assimilative functions are restored, failure 
is still encountered by imperfect distribution of the blood. The heart 
may be feeble and act imperfectly, the peripheral arterioles may con- 
tract on their lumen, and thus hinder the passage of the blood. Such 
is the condition in a large proportion of the cases of anaemia. To bring 
about a proper activity of the nutrition, it is necessary to restore the 
organs of circulation, and admit the fullest nutrient supply to all the 
tissues. It is this function of trinitrin that places it in the front rank 
of remedies for anaemia. 

Authorities referred to : 

Brunton, T. Lauder. St. Bartholomew' s Hospital Reports, vol. xii, p. 140. Prelimi- 
nary Notes on the Physiological Action of Nitro- Glycerine. 

Minor, Dr. A. J. Journal of Nervous and Mental Diseases, vol. iii, p. 355. 

Murrell, Dr. William. The Lancet, 1879, pp. 80, 113, 225. 

Robson, Mr. Mayo. The British Medical Journal, November, 1880, p. 803. 

Aconitum. — The tuberous root of Aconitum napeUus Linne (Nat. 
Ord. Ranunculaceai). (IT. S. P.) Racine d'aconit, Fr. ; Eisenhut- 
knollen, Ger. 

The Indian aconite-root, or bish, is supposed to be more powerful 
than the root of Aconitum napellus, and is preferred for the manufac- 
ture of aconitine (Fliickiger and Hanbury). 

Abstractum Aconiti. — Abstract of aconite. Dose, gr. ss — gr. j. 

Extractum Aconiti Fluidum. — Fluid extract of aconite. Dose, 
Til j— m v. 

Extractum Aconiti. — Extract of aconite. Prepared from the leaves. 
Dose, gr. \ to gr. ss. 

Tinctura Aconiti Radicis. — Tincture of aconite-root. Dose, in, j 

— m v. 

Composition. — The principal alkaloid is aconitia or aconitine^ 
which exists in two forms, crystalline and amorphous, and forms with 
acids crystallizable salts. The crystalline form of aconitine is soluble 
in chloroform, ether, and alcohol. Aconite contains also another alka- 
loid which has received various designations — pseudo-aconithie, na- 
pelline, ?iepalline, etc., which is closely allied to aconitine, and is found 
in commerce under this name. It is but slightly soluble in chloro- 
form, ether, and alcohol, and it exists also in two forms, crystalline 
and amorphous. Besides the foregoing, another base has been dis- 
covered, to which the name napelline has also been given (Hiibsch- 
mann). This is an amorphous alkaloid, having strong basic proper- 
ties, soluble in water, chloroform, and alcohol, but not soluble in ether. 
These basic substances are united with a peculiar acid — aconitic acid. 

Antagonists and Incompatibles.— Alcohol, ether, ammonia, tur- 
pentine, digitalis, heat, etc., antagonize the actions of aconite. In cases 



ACONITE. 655 

of poisoning, the stomach should be evacuated, stimulants adminis- 
tered by the stomach and rectum, and external warmth applied. Digi- 
talis has been used with considerable advantage (Fothergill). The 
intra-venous injection of ammonia may be practiced, and artificial res- 
piration resorted to. To overcome the depression of the heart's ac- 
tion, which is the capital point, the hypodermatic injection of atropine 
is indicated. As the chief danger consists in failure of the heart's ac- 
tion, the recumbent position should be strictly maintained. 

Synergists. — All the agents of this group increase the effects of 
aconite. Cold, fatigue, and all depressing emotions, are also syner- 
gistic. 

Physiological Actions. — A drop of tincture of aconite placed on 
the tongue excites a warm and pungent sensation, followed by persist- 
ent tingling and numbness. Prolonged contact with the skin causes 
similar effects upon the sensory nerves. During the medicinal adminis- 
tration of aconite in considerable doses, irritation and a sense of constric- 
tion of the fauces are experienced. Large medicinal doses produce 
gastric pain, nausea, and even vomiting. When the gastro-intestinal 
mucous membrane is in an irritable state, aconite impairs the appetite, 
hinders the digestion, and causes diarrhoea, and in the normal state of 
the membrane, increases its secretions and hastens the peristaltic move- 
ments. 

The systemic effects of aconite follow within a half -hour after its 
administration. The number and force of the heart-beats are reduced, 
and the arterial tension is lowered. The action of the skin is increased, 
and a more abundant urinary discharge takes place. If the quantity 
has been a full medicinal dose, some muscular weakness, tingling in 
the tongue, lips, and extremities, are also experienced. The whole du- 
ration of the effect is about three hours. When a lethal dose is swal- 
lowed, the symptoms begin in from five minutes to a half -hour. In a 
medical student, who swallowed by mistake a teaspoonf ul of the tinc- 
ture of the root, the symptoms began after he had reached the college, 
having walked from his quarters — the time being about twenty min- 
utes. He experienced an overpowering sense of fatigue in the lower 
extremities, and he felt, also, great muscular weakness. His eyesight 
became dim, the globes rather prominent, the pupils dilated. He expe- 
rienced great dyspnoea, and his respirations were shallow and labored. 
The pulse was at first slow and small, and at last became imperceptible. 
The surface of the body, the tongue, and breath, were cold. The 
skin was covered with a profuse sweat. He was restless, anxious, and 
sighed frequently ; but he had no stupor or convulsions. There were 
also decided numbness and tingling in the extremities, and in the 
tongue and lips. Tactile impressions were very faint, and the sense 
of pain was greatly reduced, so that he seemed almost unconscious of 
irritants. His temperature fell 2° Fahr. Under the use of heat, bran- 



656 MOTOR DEPRESSANTS. 

dy, and ammonia, be revived in the course of six hours, and, on the 
following day, although weak, there were no indications of the effects 
of the poison. 

Aconite affects the sensory nerves before the motor. It paralyzes 
first the end-organs, next the nerve-trunks, and finally the centers of 
sensation in the cord. Aconite also impairs the reflex function of the 
spinal cord ; but this effect is, doubtless, secondary to the sensory 
paralysis. The power,of voluntary movement continues after the cessa- 
tion of the reflex functions ; but it is finally lost. The arrest of motil- 
ity is due to the action of the poison on the motor centers of the cord, 
and subsequently on the nerve-trunks. 

Aconite, applied directly to the heart, lessens the number and force 
of its beats, and finally arrests its action in the diastole. The cardiac 
muscle, after the cessation of its movements, does not respond to gal- 
vanic excitation. Aconite lowers the arterial pressure, as well as less- 
ens the force of the heart-beat. From these facts it may be concluded 
that it is a direct cardiac poison, affecting its ganglia and muscle, and 
also a sedative to the vasor-motor nervous system. It is also a respira- 
tory poison, in virtue of its paralyzing action on the muscles of respi- 
ration ; but the action of the heart ceases before the respiratory move- 
ments. 

Aconite increases elimination by the skin and kidneys. With in- 
creased discharge of water, there takes place, also, increased excretion 
of solids. 

Therapy. — The monopoly by homoeopathic practitioners of the use 
of aconite has aroused a prejudice against it, which has discouraged its 
employment. Aconite is, however, an antagonist to the fever-pro- 
cess ; it is not applicable in accordance with the so-called law of simi- 
lars. It is used by these quacks because it is a powerful agent which 
will produce manifest effects in small doses, that may easily be dis- 
guised. 

The author can quite agree with Dr. Ringer in the statement that 
aconite is a very valuable medicine, in the class of cases to which it is 
adapted. It lessens the pulse-rate, lowers arterial tension, diminishes 
abnormal heat ; it therefore antagonizes that condition of the organism 
known as fever. As it also slows the respiratory movements, and thus 
lessens the amount of work done by the breathing apparatus, it is espe- 
cially indicated in inflammatory states of the respiratory organs. As 
it diminishes the sensibility of the sensory nerves, it is useful in certain 
forms of neuralgice. As it induces muscular weakness and lowers the 
activity of the reflex functions, it is indicated in morbid states charac- 
terized by an excess of motor activity. 

Tonsillitis, acute pharyngitis, ulceration of tonsils, when accom- 
panied by fever and elevated arterial tension, are greatly relieved by 
the use of the tincture of aconite. From a half -drop to one drop every 



ACONITE. G57 

half -hour, until an impression is made on the fever-movement, and then 
every hour or two, is the best mode of administration. In acute catarrh 
(nasal and faucial), acute otitis, and in acute catarrhal bronchitis, the 
best results may be obtained by the use of aconite, as above described. 
The author's observations entitle him to speak with confidence of the 
good effects of this remedy in catarrhal and fibrinous pneumonia. It 
is more especially serviceable before exudations have taken place, but 
is not without utility at any stage, provided the inflammatory process 
continues. It not only abates the symptoms, but it favors the removal 
of the products of inflammation, by increasing elimination through the 
skin and kidneys. The use of aconite is not incompatible with the 
employment of other measures which may be needed ; but, generally, 
in fibrinous pneumonia, aconite is sufficient up to the period of crisis. 
The author has witnessed excellent results from the use of aconite in 
small doses frequently repeated (one drop every hour) in lowering the 
temperature of phthisis, especially when new districts of pulmonary 
tissue are invaded by pneumonitis. For the treatment of acute pleuri- 
tis, previous to the stage of effusion, no remedies are more effective than 
aconite and opium. Tfr Tinct. aconiti rad., 3 ij ; tinct. opii deodor., 
3 vj. M. Sig. : Eight drops in icater every hour or two. If the 
pain is severe, a larger dose of opium should be administered, when 
the effect can be maintained by the quantity directed in the above 
prescription. 

Overaction of the heart, with hypertrophy and without valvular 
lesion, especially if there be present a condition of plethora, is bene- 
fited by a quantity of aconite sufficiently large to moderate the cardiac 
movements. 

Aconite is contraindicated in inflammatory states of the gastroin- 
testinal mucous membrane. It is very serviceable in acute congestion 
of the liver and hepatitis: it diminishes the fever, and, by causing free 
transpiration, lessens the pungent heat of the skin. Peritonitis is best 
treated by a combination of aconite and opium, as described above for 
pleuritis. Generally, the opium needs to be given in somewhat larger 
quantity in peritonitis than in pleuritis. In pelvic peritonitis, puer- 
peral metritis, and peritonitis, aconite is indicated, and is of unques- 
tionable utility, provided there be present a condition of sthenic reac- 
tion. A condition of adynamia, on the other hand, always contraindi- 
cates the use of aconite. 

The simple fevers of childhood, febricula, ephemeral fever, arising 
from various causes, as cold, fatigue, excitement, etc., are best treated 
by small and repeated doses of aconite. The remedy induces sweat- 
ing, and then the fever-movement subsides. The hot stage of intermit- 
tents and remittent fever, if any febrifuge is required, maybe relieved 
of its intensity by frequently-repeated doses of aconite. The continued 
fevers are not benefited by this remedy unless a condition of hyperpy- 
43 



658 MOTOR DEPRESSANTS. 

rexia is threatened, when aconite may be used in connection with other 
antipyretic remedies. 

Aconite possesses the highest value in the eruptive fevers, especially 
in scarlet fever. There are two conditions of this disease especially 
requiring the use of aconite — the eruptive stage, and the period of des- 
quamation, if, as is usual, a marked rise of temperature takes place at 
this period of the disease. Several important purposes are subserved 
by the use of this remedy : it lowers the fever-heat, favors the action 
of the skin and kidneys, and checks the nasal, faucial, and aural in- 
flammations, which constitute such troublesome complications and 
sequelae. The particular utility of aconite in measles consists in its 
power to arrest the catarrhal pneumonia, one of the most serious com- 
plications of this disease. We have no remedy more useful in erysipe- 
las — idiopathic, so called, and not arising from trauma ; but, on the 
other band, Ringer describes an apparently erysipelatous inflammation 
following vaccination, which is quickly cured by aconite. According 
to the author's observations, it is facial erysipelas which is most de- 
cidedly benefited, and cases characterized by sthenic reaction. When 
there is a state of adynamia present, the eruption being dusky and the 
cutaneous circulation languid, belladonna is preferable to aconite. 
When, in acute rheumatism, there are much heat and a dry skin, instead 
of the usual sweating, aconite is very serviceable. It affords very con- 
siderable relief in muscular rheumatism when there is much fever. 

In acute inflammation of the cerebral and spinal meninges, and in 
cerebrospinal meningitis before effusion has taken place, aconite is as 
serviceable as in other acute inflammations. It is generally advisable 
to combine opium with it, especially in cerebro-spinal meningitis. In 
acute maniacal delirium, and in mental disorders generally, when there 
is much motor activity, with vascular excitement and increased ar- 
terial tension, aconite is useful, but is not so effective as gelsemium. 
Aconite renders important service in the active form of acute cerebral 
congestion. 

Neuralgia, when accompanied by arterial excitement and muscular 
spasm, is relieved by aconite ; but generally the neuralgias are much 
more successfully treated by hypodermatic injections and galvanism. 

It is asserted by Ringer, and also by Phillips, that sudden suppres- 
sion of the catamenial flow, caused by cold, can be relieved by aconite, 
in drop-doses of the tincture every half -hour or hour. The author can 
assert that this remedy has a high degree of utility in congestive dys- 
menorrhcea, occurring in plethoric subjects. These are cases, also, in 
which gelsemium is so undoubtedly beneficial. 

Aconitine in Trig emincd Neuralgia. — Remarkable results have late- 
ly been obtained by the use of Duquesnel's aconitine in this malady. 
The following formula is proposed by the New York Therapeutical 
Society : r> Aconitinae (Duquesnel's), gr. ^ ; glycerini, alcohol., aa 3 j ; 



VERATRUM V1RIDE. 659 

aquam inenthae pip., ad § ij. M. Dose, a teaspoonful. The close is 
sometimes very slowly and cautiously increased to £. Although it 
does not succeed in all cases of tic-douloureux for obvious reasons, it 
relieves remarkably in others (Seguin). 

Napelline. — Duquesnel has lately rediscovered (?) a principle to 
which he has applied the name napelline. Its physiological actions 
have been studied by Laborde. He finds it weaker than aconitine, 
and was able to administer without ill results from a half (J) grain to 
three fifths (f ) of a grain. It possesses valuable hypnotic properties, 
and it is proposed to use it as a substitute for opium and chloral. On 
trial it proved to be an effective remedy in neuralgia, and as a sleep- 
producing agent in cases of wakefulness, mental excitement, and allied 
conditions. If further investigations confirm those observations, it 
will be a valuable addition to the materia medica. 

Authorities referred to : 

Achscharumow, Dr. Archiv fur Anat. und Physiologie, 1866, p. 255. 

Bohm und Ewers. Ueber diephys. Wirk., etc. Archiv fur experimentelle Pathologie 
und Pharmakologie, ISIS, p. 385. 

Fothergill, Dr. J. M. The British Medical Journal, 1870. Ibid., January 17, 1874. 

Hottot, M. Journal de V Anatomic et de la Physiologie, 1864, p. 113. 

Hottot et Liegeois. Ibid., 1861, p. 520. 

Husemann, Drs. Theo. und Aug. Pflanzensloffe, p. 210. 

Husemann, Dr. Theod. Handbuch der gesammten Arzneimittellehre, p. 1153. 

Phillips, Dr. C. D. F. The Practitioner. Ibid., Materia Medica and Therapeutics, 
1874, p. 2. 

Ringer, Dr. Stdnet. Handbook of Tlierapeutics, article Aconite. 

Taylor, Dr. A. S. On Poisons, third London edition, p. 747. 

Van Praag, Dr. L. Archiv fur path. Anat., vii, p. 438. 

Veratrum Viride. — American hellebore. The rhizoma and rootlets 
of Veratrum viride Aiton (Nat. Ord. Melanthaceoe). 

Mctractum Veratri Viridis Fluidum. — Fluid extract of veratrum 
viride. Dose, in, ij — tu v. 

Tinctura Veratri Viridis. — Tincture of veratrum viride. Dose, 
Til ij— m v. 

Yeratrina. — Yeratrine. An alkaloid or mixture of alkaloids, pre- 
pared from the seeds of Asagrcea officinalis Lindley (Nat. Ord. Me- 
lanthacece). Is pulverulent, grayish-white, inodorous, but very irritant 
to the nostrils. It has an acrid, bitter taste, causing a sensation of 
tingling with numbness in the tongue. It is very slightly soluble in 
water, but readily and wholly dissolved by alcohol. It has an alkaline 
reaction. 

Oleatum Veratrinm. — Oleate of veratrine. Yeratrine, 2 parts; 
oleic acid, 98 parts. (For external use.) 

TInguentum Veratrinm. — Yeratrine ointment. Yeratrine, 4 parts ; 
alcohol, 6 parts ; benzoinated lard, 96 parts. (For external use.) 



660 MOTOR DEPRESSANTS. 

Composition. — Veratrum album, veratrum viride, and veratrum 
sabadilke, correspond closely in chemical composition, and the first two 
in botanical characteristics. Sabadilla is only used as the source of 
the alkaloid veratrine. The alkaloids of veratrum album &re jervine 
and veratralbine (Mitchell). Veratrum viride contains two alkaloids 
also — -jervine and veratroidine. The alkaloid jervine is found in both 
plants, is the same in chemical action and in physiological effects, and 
may, therefore, be considered identical. There are very close affinities 
between the veratralbine of Mitchell and the veratroidine first discov- 
ered by Bullock, but they are not the same ; they differ as respects 
their chemical relations, and also in physiological properties, veratral- 
bine being much more powerful than jervine and veratroidine. Vera- 
trum album and veratrum viride contain abundance of soft resin, 
which, when pure, is nearly, if not quite, inert. As the alkaloid jer- 
vine is with difficulty separated from the resin, it is probable that the 
physiological activity, ascribed to the resin by some observers, is really 
due to the presence of the alkaloid. 

Antagonists and Incompatibles. — The effects of veratrum viride 
on the heart are counterbalanced by alcoholic stimulants, opium, and 
ammonia. When dangerous symptoms are produced, the recumbent 
position should be enforced, alcoholic stimulants should be adminis- 
tered by the stomach and rectum, and dry heat should be applied to 
the body. Ammonia may also be given by the stomach or by intra- 
venous injection, and, if nausea and vomiting persist, morphine may be 
administered subcutaneously. The tincture of opium, in stimulant 
doses, may be prescribed with the alcoholic stimulants. 

Syneegists. — The vaso-motor depressants — tobacco, lobelia, aco- 
nite, etc. — are synergistic. Blood-letting, hemorrhage, purgatives, 
and all agencies which diminish vital power, increase the effects of 
veratrum. 

Physiological Effects. — In the remarks which follow, veratrum 
viride only is referred to. 

Applied to the skin, veratrum viride excites redness and heat, and, 
to the Schneiderian mucous membrane, it causes violent sneezing. It 
is a prompt and efficient emetic, but its operation is accompanied with 
intense nausea and depression, and the vomiting is often violent and 
persistent. The contents of the stomach are at first evacuated, and 
afterward of the gall-bladder, so that it has been supposed to possess 
the power to increase the secretion of bile. It does not generally 
purge, but occasionally profuse watery evacuations have been produced 
by it, and rarely severe hypercatharsis. Its alkaloids enter the blood 
with facility. The power which veratrum viride has to affect the car- 
diac movements and the vascular tonus is its most characteristic prop- 
erty. It lowers, in a remarkable manner, the number and force of the 
cardiac pulsations. The pulse may be reduced to fifty, forty, or even 



VERATRUM V1RIDE. G61 

thirty-five per minute, and its force correspondingly diminished. Ac- 
cording to Linon, the arterial tension is raised, as shown by the sphyg- 
mograph. By very careful administration, this reduction in the pulse- 
rate may sometimes be accomplished without inducing nausea and 
vomiting, but usually vomiting can not be prevented when the remedy 
is pushed to this extent. When the pulse is reduced very decidedly, 
the patient being in the recumbent posture, a change to the erect posi- 
tion at once alters its character, and it becomes extremely rapid, 
thready, and feeble. 

Very great depression of the powers of life is produced by large 
doses. The action of the heart becomes exceedingly weak, the pulse 
almost indistinguishable, the vomiting and retching extreme, the sur- 
face of the body cold. and. covered with a cold sweat, the temperature 
reduced. There are also produced faintness, dimness of sight, dilata- 
tion of the pupils, giddiness, great muscular weakness, shallow and 
slow respiration ; sometimes somnolence, coma, and insensibility, with 
stertorous breathing. Notwithstanding the very formidable symp- 
toms produced by large doses, fatal results have been extremely rare. 
An ounce of the tincture has been swallowed without causing death 
(Norwood). The prompt emesis which it produces is probably the 
explanation of its lethal inactivity ; for, in the act of vomiting, the 
medicine is ejected with the first matter from the stomach. Suspen- 
sion of the medicine and free stimulation quickly remove the most 
alarming symptoms of depression. 

The experimental investigations into the actions of jervine and 
veratroidine, made by Wood, Peugnet, and others, have shown that 
the physiological actions of veratrum viride are the sum of the ac* 
tions of the alkaloids. The nauseating and emetic qualities of the 
drug are due, chiefly, to veratroidine, and to a slight extent to the 
resin. Both alkaloids depress the functions of the spinal cord, and 
destroy its reflex activity ; but they do not impair the excitability of 
the nerves, nor the contractility of muscles. Veratroidine, according 
to Wood, first stimulates the inhibitory cardiac nerves to an extraor- 
dinary extent, and afterward paralyzes them ; but the evidence which 
he adduces in favor of the singular statements on this point are far 
from satisfactory. Both alkaloids lower the blood-pressure, by dimi- 
nution of vaso-motor tonus, and paralyze the cardiac muscle, and 
probably also its contained ganglia. They cause death by asphyxia — 
by paralysis of the muscles of respiration. The cerebral effects which 
have been noted in man, and the convulsions in animals, are doubtless 
due to the accumulation of carbonic acid in the blood. 

Theeapy. — The best preparation for administration is the tincture. 
As the therapeutic properties of veratrum viride depend, chiefly, on 
the jervine, an attempt may be made in the future to supply this alka- 
loid in sufficient quantity for administration ; but, at present, the pro- 



662 MOTOR DEPRESSANTS. 

cesses involved in its preparation are too intricate and expensive. Aid 
the effect of veratrum viride quickly reaches its maximum, if it be de- 
sired to maintain the pulse-rate at a constant level, the doses must not 
be at a longer interval than two hours. The effect must be main- 
tained by increasing doses, if necessary, and the recumbent posture 
must be rigidly enforced. 

The emetic property of veratrum viride is never applied in prac- 
tice ; too much depression is produced by it. The chief use of this 
agent is to depress the action of the heart and to lower the vaso-motor 
tonus. In simple hypertrophy of the heart, without valvular lesion, it 
diminishes the overaction and thus gives relief to the most distress- 
ing symptom. The irritable heart, so frequently found associated 
with and dependent on the excessive use of tobacco, on mental excite- 
ment and irascibility of disposition, and on overstrain, is relieved by 
this remedy, provided no valvular lesions coexist. The hypertrophy 
of the cardiac muscle, and the abnormal arterial tension, which ac- 
company the chronic form of albuminuria, are alleviated by veratrum 
viride. Moderate doses of the tincture (five drops ter die) usually 
suffice in these cases. When there are valvular lesions, and when 
the cardiac muscle is enfeebled from any cause, this agent is inad- 
missible. 

Excellent results are sometimes obtained in aneurism by the use of 
veratrum viride. In the various surgical expedients for the cure of 
aneurism (forced flexion, compression, ligation), this remedy, used to 
depress the circulation, renders an important service, by lessening the 
force with which the blood is propelled, and the number of the cardiac 
contractions. In this way, coagulation of the blood in the aneurismal 
sac is greatly favored. In the case of large internal aneurisms — of 
the innominata, aorta, etc. — veratrum viride is a powerful adjunct to 
rest and other means of treatment. Some precautions are necessary, 
however, in the administration of this remedy. As the utmost slow- 
ing of the circulation consistent with safety may be required, a suffi- 
cient quantity of the tincture must be administered to accomplish this 
object, and the effect produced is the only measure of the amount to 
be given. The result must be accomplished, if possible, without caus- 
ing vomiting. The patient should, therefore, remain absolutely in the 
recumbent posture, and a little opium should be prescribed with the 
veratrum viride. Active haemorrhage, occurring in the plethoric, is 
sometimes stopped by full medicinal doses of this drug. 

There can be no doubt that veratrum viride renders an important 
service in acute parenchymatous congestion — of the brain, lungs, liver, 
and other organs. Its utility ceases when exudations have taken 
place : its action is confined to the influence which it has in diminish- 
ing the blood-supply to the affected organs. The changes produced 
by inflammation are in no wise affected by veratrum viride. Much 



VERATRUM VIRIDE. 663 

that is extravagant has been written in regard to its curative influence 
in pneumonia, but we need not be surprised at this, when we reflect 
that our knowledge of the natural history of this disease is only of 
recent origin. Those who knew nothing of the period of crisis of 
pneumonia naturally attributed the defervescence of temperature to 
the effect of the remedy. It is not to be denied that in the very in- 
cipiency of pneumonia, before fibrinous exudation has taken place, 
veratrum viride, by lessening the amount of blood circulating in the 
lungs, may render an important service, but when hepatization occurs 
its good effects cease. The same observations are true of other pa- 
renchymatous inflammations, and equally so of serous inflammations. 

Veratrum viride has been much extolled as a remedy for reducing 
the pulse-rate and the temperature in typhoid and other fevers (Nor- 
wood). It is true, these effects may be procured by it, but that any 
influence is exerted in this way, over the course and duration of a 
fever, seems highly improbable. The chief dangers in fever being the 
occurrence of cerebral or cardiac paralysis due to the persistent eleva- 
tion of the temperature, it is unwise to use a powerful cardiac depres- 
sant, although it has the power to lower the temperature somewhat. 
There is, however, a condition of things arising in the course of fevers 
— viz., delirium, fcrox — in which, when dependent on arterial excite- 
ment, much good may be accomplished by the use of veratrum viride. 

The excitement of acute mania, of maniacal delirium, and other 
forms of mental disorder in which a condition of cerebral hyperemia 
may be supposed to exist, is successfully combated by veratrum viride. 
In a private communication, Dr. Sullivan, of San Francisco, informs 
me that this agent ( 3 ss of the fluid extract every fifteen minutes until 
nausea or vomiting ensues) is u invaluable in puerperal convulsions" 
Barker, in his "Puerperal Diseases," had already called attention to 
its utility, and Boyd confirms the previous observations. Increasing 
experience adds to the testimony regarding its exceptional value in 
the relief of this formidable malady. 

Veratrine is used only externally, and for the relief of neuralgia, 
headache, myalgia, etc. The official unguentum veratrim is the form 
in which it is employed — a small quantity being rubbed in over the 
seat of pain. 

Authorities referred to : 

Boyd, Dr. American Practitioner, January, 18*78. 

Briesemann, C. Mikroskopische Untersuchungen uber die Wirkung des Digitalin, 
Veratrinu. Ergotin auf die Cirkidation, Rostock, 1869. 

Linon, M. Gazette Medicate de Strasbourg. Bulletin General de Therapeutique, vol. 
lxxvi, p. 94. 

Mitchell, Charles L. Transactions of American Pharmaceutical Association, vol. 
xxii, p. 397. The Active Principles of the Officinal Veratrums. 

Norwood, Dr. W. C. The Authorship and Therapeutical Powers of Veratrum Viridt, 
more fully examined, Albany, 1868, p. 39. 



6(34 MOTOR DEPRESSANTS. 

Oulmont, M. Bulletin General de Tlierapeutique, vol. lxxiv, p. 153. 
Ibid. Communication of paper by MM. Zuber and Hirtz to Society of Therapeutics, 
Bulletin General, vol. lxxvi, p. 468, et seq. 

Percy, Dr. S. R. Transactioyis of American Medical Association, 1864. 

Peugnet, Dr. Eugene. The Medical Record, May, 1872. 

Squarey, Dr. The Practitioner, 18*70, vol. i, p. 211. 

Wood, Dr. II. C. The American Journal of the Medical Sciences, January, 1870. 

Pulsatilla. — Pasque-flower. The herb of Anemo7ie pulsatilla and 
Anemone pratensis Linn6, and of Anemone patens Linne, var. Nuttal- 
liana Gray (Nat. Ord. Ranunculaceai), collected soon after flowering. 
(IT. S. P.) Pulsatille, Fr. ; Kuchenschelle, Ger. 

Preparations. — There are no official preparations. The tincture 
is the form usually employed in medical practice, the dose of which 
varies from one minim to twenty minims. 

Composition. — The peculiar powers of the plant depend on the 
presence in it of an alkaloid — anemonine, a camphor. Anemonine 
crystallizes in prisms — the regular rhombic system — and is hardly at 
all soluble in cold water and in alcohol (Husemann). Pulsatilla also 
contains a peculiar acid — anemonic acid. 

Antagonists and Incompatibles. — The caustic alkalies, tannic 
acid, and the metallic salts generally, are chemically incompatible. 
From the physiological standpoint, pulsatilla is antagonized by alco- 
hol, by opium, digitalis, etc. 

Synergists. — The effects of pulsatilla are promoted by the para- 
lyzers, especially by the other members of the same family — notably, 
by aconite, veratrum viride, etc. 

Physiological Actions. — The local effects of pulsatilla (the fresh 
plant) are those of an irritant ; and, after prolonged contact, even 
caustic effects are produced. Applied to the tongue, it gives rise to 
tingling, burning, followed by numbness — effects very similar to those 
caused by aconite. On the intestinal mucous membrane it has very 
pronounced irritating effects. The active principles diffuse into the 
blood with facility. Depression of the heart's action, lowering of the 
arterial tension, and declination of temperature, are caused by pulsa- 
tilla. It is a paralyzer of motility and sensibility, but, as respects the 
motor functions, it is not known whether it impairs the contractility 
of muscle or the irritability of nerve ; and, as respects sensation, it has 
not yet been determined whether the lessened sensibility is due to an 
influence which this remedy has on the spinal cord, on the nerve- 
trunks, or on the peripheral expansion — end-organs of the sensory sys- 
tem. Dilated pupils, hebetude of mind, stupor, coma, and convulsions, 
are cerebral symptoms which occur after a lethal dose has been ad- 
ministered. These cerebral effects may be due to a primary action of 
pulsatilla on the brain, or to the carbonic-acid poisoning and the anae- 
mia. When the action of the heart and the respiration are very feeble, 



GRINDELIA. 665 

carbonic acid accumulates in the blood, and an extreme degree of cere- 
bral anaemia ensues. Coma, convulsions, and insensibility, are natural 
effects of these causes. Nothing is positively known as to the time 
and mode of elimination of anemonine, but it is probable that excre- 
tion takes place by the kidneys. 

The production of any given physiological effect will, of course, 
depend on the genuineness of the drug. The active principles are 
volatile, and often disappear in the process of desiccation. 

Therapy. — Owing to the irritating action of pulsatilla, it is not 
suited to the treatment of gastro-intestinal disorders, especially when 
a state of inflammation exists. Notwithstanding this local irritant 
effect, homoeopathists employ it for the relief of dyspepsia and the 
accompanying mental symptoms ; but, in coming to conclusions as to 
its curative value, they calmly ignore the natural history of these 
maladies. 

Pulsatilla is adapted to the treatment of acute inflammation of the 
nasal, faucial, laryngeal, and bronchial mucous membrane — acute 
catarrh. It is not proper in those cases when accompanied by gastro- 
intestinal disturbance. It is clearly useful in acute inflammation of 
the cerebral and spinal meninges. 

It is used by the homoeopathists in the treatment of catarrhal oph- 
thalmia, by internal and local applications ; and they hold that it is 
very efficacious in certain diseases of the uterus, on which organ they 
suppose it to have a special or specific action. Sudden arrest of the 
menstrual flow, whether caused by moral emotion or by cold, may be 
relieved, and the effects prevented, by pulsatilla. As aconite is very 
useful under the same circumstances, it may be assumed that good 
results may be had by the administration of pulsatilla. 

Authorities referred to : 

Gubler, Prof. A. Codex Medicamentarius, p. 17. 
Husemann, Des. Aug. und Theod. Die Pflanzen&toffe, p. 795. 
Phillips, Dr. Charles D. F. Materia Medica and Therapeutics, p. 17. 

Grindelia. — The leaves, stems, and flowers of Grindelia robusta 
Nuttall (Nat. Ord. Composite). 

Preparations. — JExtractum Grindelice Fluidum. — Fluid extract 
of grindelia. Dose, tt[ x — 3 j. 

Extractum Grindelim. — Extract of grindelia. (Not official.) Dose, 

g r - j— gr- v. 

Composition. — An alkaloid with basic properties has been isolated 
(Rademaker), but its chemical relations have not been fully made out. 
The plant contains also a volatile oil, and a resin, to which its physio- 
logical activity is doubtless in part due. 

Antagonists and Incompatibles. — Water precipitates the oleo- 
resin. The mineral salts and caustic alkalies are chemically incom- 



666 MOTOR DEPRESSANTS. 

patible. Opium, the cerebral stimulants, alcohol, strychnine, picrotoxin, 
etc., are opposed as respects the physiological actions. 

Synergists. — All motor depressants increase the actions of grin- 
delia. 

Physiological Actions. — The taste of grindelia is rather pungent, 
eYen acrid, and in the stomach it excites a sensation of warmth. The 
local stimulant effect is such that it promotes the appetite and diges- 
tion ; but, if too long continued, or in too great quantity, it excites 
gastric uneasiness. Grindelia slows, somewhat, the heart and respira- 
tory movements. When administered in sufficient quantity, decided 
cerebral effects are produced. It dilates the pupil and induces sleep. 
During this condition of hypnotism, the general cutaneous sensibility 
is much reduced, and reflex movements become sluggish. Motility is 
also affected, the paresis beginning in the hind extremities. Its toxic 
powers are by no means great, two drachms of the fluid extract be- 
ing required to induce sleep in small rabbits. It affects other warm- 
blooded animals, and also frogs, in the same way. When death 
ensues, it is from paralysis of the muscles of respiration. Elimina- 
tion takes place by the pulmonary mucous membrane, and chiefly by 
the kidneys. 

Therapy. — The most important uses of grindelia, thus far devel- 
oped, are in the treatment of the respiratory neuroses. Its utility in 
the treatment of asthma, especially the so-called spasmodic asthma, is 
certainly great ; few cases fail to be relieved at once. Besides the 
stomach administration, it may be given in the form of fumes, accord- 
ing to the following plan : The plant is steeped in a saturated solu- 
tion of nitre, dried, when it may be ignited on an ordinary tin plate, 
the patient inhaling the fumes as they arise, or the fumes in the air of 
a small, closed apartment. This preparation may also be rolled into 
cigarettes, and smoked with or without the addition of tobacco, stra- 
monium, lobelia, etc. The fluid extract of grindelia may be incorpo- 
rated with other asthmatic remedies, in an extemporaneous prescrip- 
tion. For example : 1} Ext. grindelia fluid., 3 ss ; ext. lobeliae fl., 
3 ij ; ext. belladonnas fl., 3 j ; potassii iodidi, 3 iij ; glycerini, 3 iij. 
M. Sig. : A teaspoonful, as necessary. 

Cough by imitation and habit, whooping-cough, and the spasmodic 
difficulty of breathing which accompanies various pulmonary and car- 
diac diseases, hay-asthma, etc., are helped by grindelia. It is also an 
effective remedy for bronchitis, after the subsidence of acute symp- 
toms ; for chronic bronchitis and bronchorrhoza, and for the bronchitis 
of emphysema. 

Besides the above diseases for which grindelia has been used with 
success, it will prove advantageous in chronic pyelitis, chronic cystitis, 
etc. In these diseases local application of the oleo-resin takes place 
all along the urinary tract. 



PHYTOLACCA. 667 

Authorities referred to : 

Crowe, Dr. John E. Louisville Medical Xews, April, 1876. 
Fiske, Dr. H. M.- The Pacific Medical and Surgical Journal. 
Rademaker, Dr. C. J. Louisville Medical News. 

Phytolacca. — Phytolacca bacca. — The fruit of Phytolacca decandra 
Linne (Nat. Ord. Phytolaccacece). (IT. S. P.) Poke-berries. 

Phytolacca} radix. — The root of Phytolacca decandra — poke-root. 

Preparations. — Extr actum Phytolacca^ Fluidum. — Fluid extract 
of phytolacca. Dose, rrt v — 3 j. (Not official.) 

Tinctura Phytolaccce. — Tincture of phytolacca. Dose, tf|, x — 3 j. 
(Not official.) 

Composition. — Claussen has obtained a neutral principle, which he 
has named phytolaccin, but this should not be confounded with an 
impure resin called by the eclectics "phytolaccin." Claussen's phyto- 
laccin occurs in silky, shining crystals, soluble in alcohol and ether, 
but not in water. A peculiar acid, phytolaccic acid, has also been 
found in the berries by Terail. It is uncrystallizable, but soluble in 
water and in alcohol. 

Antagonists and Incompatibles. — Alcohol, ether, opium, digitalis, 
etc., oppose the action of phytolacca. 

Synergists. — All depressing agents, the paralyzers, and emetics, 
contribute to the effects of phytolacca. 

Physiological Actions. — Poke is nauseant and emetic, and these 
effects occur, whatever may be the mode of administration. The emesis 
does not occur at once ; there is a slowly-accumulating anguish ; vomit- 
ing does not result for an hour, and the vomiting is accompanied with 
great depression. Rutherford has shown that the eclectic preparation 
phytolaccin has decided cholagogue property — ranking, indeed, among 
the most effective of the agents influencing the flow of bile. 

Phytolacca lowers the rate of cardiac movement and the respiration, 
but does not alter the rhythm. It is a paralyzer, the loss of power 
occurring first in the hind extremities. The impairment of motility is 
not due to an action of this agent on the motor nerve or on the muscle 
— for the irritability of the nerve and the contractility of muscle remain 
unaffected when a lethal dose of phytolacca has been given. The action 
is on the spinal cord, chiefly on the medulla. In rabbits, violent trem- 
bling occurs, and convulsions, partly tonic, partly clonic, are produced. 
Death ensues from paralysis of respiration ; for in frogs, when all signs 
of life have ceased, the heart is found to be in action, on opening the 
chest. In cases of accidental poisoning, convulsions of a tetanic char- 
acter have been observed. Elimination takes place chiefly by the 
kidneys. 

Therapy. — Poke has been proposed as an emetic, but the slowness 
of the action, and the great depression of the powers of life which it 



G68 MOTOR DEPRESSANTS. 

causes, have prevented, and will ever prevent, its employment for this 
purpose. 

Alterative powers have been ascribed to it, and cases supposed to 
be malignant have been cured ; but these results were probably in- 
stances of the post rather than the propter hoc. Ulcers, cutaneous dis- 
eases, and ophthalmia, are maladies which have been reported cured. 
Fenner reported a case of granular conjunctivitis cured by it, and in 
the same issue of the journal there is an editorial note, affirming the 
remarkable powers of the remedy in this disease. If it really does 
cure this disease when given by the stomach, poke is a remedy of ex- 
traordinary value. The evidence is strong that phytolacca does pos- 
sess considerable power to promote the healing of varicose and other 
ulcers of the leg (Tidd). A soft extract is spread on muslin, and kept 
applied to the surface of the ulcer. Obstinate eczema has been cured 
in the same way. The pain and inflammation of burns may be as- 
suaged by the same application, and the healing greatly facilitated. 
How far the effect is merely mechanical does not appear. 

It has long been known that phytolacca is a serviceable remedy in 
chronic rheumatism. But the therapeutical application of this remedy 
most deserving of consideration is the treatment of inflamed breasts. 
There seems to be no reason to doubt that phytolacca possesses the 
remarkable property of arresting an inflammation of the mamma, and 
preventing suppuration. For this purpose the fluid extract may be 
given internally, and the solid extract spread on a cloth and kept 
applied to the breast which is the seat of the inflammation. The pos- 
session of this property to prevent suppuration in the breast implies 
the existence of the same property in threatened suppuration in other 
glandular organs. As the fact is entirely empirical, and rests on no 
physiological action of the drug, it can only be determined by further 
trials whether it will check suppuration elsewhere. 

Authorities referred to : 

Biggers, Dr. G. W. The American Journal of the Medical Sciences, vol. lxv, p. 275. 
Dutcher, Dr. A. P. Tlie Cincinnati Lancet and Observer, June, 1859. 
Tidd, Dr. C. H. The Clinic, vol. v, p. 253. 

Ailanthus. — The bark of A. glandulosa, a well-known and abundant 
shade-tree. (Unofficial.) 

Preparations. — Fluid extract. Dose, th, x to 3 j. Bark, gr. x — 

3j- 

Composition. — The most important constituent is the oleo-resin. 
It contains, also, a volatile oil, which is extremely diffusible and pow- 
erful, and a bitter principle. 

Actions and Uses. — The taste is bitter and somewhat acrid. It is 
strongly nauseant, and the nausea is accompanied with weakness, ver- 
tigo, and cold sweating. It possesses decided purgative property, the 



MUSCARINE. 669 

stools being large and watery. It has considerable power as a vermi- 
fuge, and is effective when employed against taenia. The action of the 
heart is at first increased, but is subsequently slowed, the pulse becom- 
ing small and weak. Respiration is similarly affected, and death en- 
sues in animals by paralysis of the muscles of respiration. 

On the brain and nervous system ailanthus acts as a paralyzer, the 
loss of power beginning in the hind extremities. The paralyzing ac- 
tion seems to depend on the volatile oil, while the purgative and an- 
thelmintic effects are possessed by the oleo-resin. 

Therapy. — The most important application of ailanthus is in the 
treatment of tape-worm. For this purpose the oleo-resin, or, better, a 
decoction of the fresh bark ( 3 j — 1 iv), may be used. The oleo-resin 
has the advantage in being a permanent preparation, whereas the bark 
loses its strength in the process of drying. 

Agaricin {Agaric Acid). — Obtained from Agaricus albus. Crys- 
tallizes in needles. Dose, gr. -^ to gr. J. Given in pill form. It is 
an efficient remedy for pathological sweating, but rather slow in 
action, beginning to have an effect in six to ten hours. It may cause 
nausea and diarrhoea, when it should be combined with a little 
opium. 

Muscarine. — The alkaloid of Amanita muscaria, the fly-fungus. 

Properties. — Muscarine is an alkaloid with strong basic properties, 
and combines with acids to form salts. It has the consistence of sirup, 
is without odor, free from taste, and is readily soluble in water and in 
alcohol, but is insoluble in ether and in chloroform. 

As muscarine is but slightly irritating to the tissues, it may be 
used subcutaneously. The dose ranges from one eighth of a grain to 
two grains. 

Antagonists. — The actions of muscarine are antagonized by atro- 
pine (Schmiedeberg and Koppe), by digitaline (Bohm), and by eserine 
(Prevost). By atropine it is antagonized at all points. When the 
heart is arrested by muscarine, it possesses the capability of again re- 
newing its action under the influence of a large number of agents, but 
atropine possesses this property in the highest degree (Alison). Mus- 
carine arrests the heart in diastole by stimulating the intracardiac in- 
hibition apparatus — atropine paralyzes this apparatus (Prevost) ; mus- 
carine causes intense dyspnoea by inducing strong contraction of the 
pulmonary arteries — atropine relaxes this spasm, unloads the right cavi- 
ties of the heart, and respiration is resumed ; muscarine lowers, atro- 
pine raises the blood-pressure ; muscarine tetanizes the muscular layer 
of the intestine — atropine induces a paresis of the same ; muscarine in- 
creases the secretions of liver, pancreas, and intestinal mucous mem- 
brane — atropine arrests these secretions ; muscarine stops the renal 



G70 MOTOR DEPRESSANTS. 

secretion — atropine restores it ; muscarine causes sweating, salivation, 
and lachryniation — atropine dries them all ; muscarine contracts the 
pupil — atropine dilates the pupil. For the quantity producing a given 
physiological effect, the power of the two agents is very unequal, 
atropine being much stronger. An atropinized eye dilated to a cer- 
tain point will not be contracted by the quantity of muscarine suffi- 
cient when unopposed to induce a marked degree of myosis ; but a 
much larger quantity may overcome the atropine. The same fact is 
true throughout the whole range of their antagonistic action. 

In frogs poisoned by digitaline, the cardiac movements recommence 
and are maintained for hours by the application of a solution of mus- 
carine. The same fact is true of tobacco and physostigma : the heart 
arrested by these agents recommences movements when muscarine is 
applied, and vice versa. 

Synergists. — The motor depressants synergize some of the actions 
of muscarine. A close correspondence exists between pilocarpine and 
muscarine. They both cause nausea, diarrhoea ; muscarine at first 
quickens then slows, and pilocarpine quickens the pulse ; they both 
flush the face and produce free perspiration and salivation ; they both 
cause frontal headache ; both contract the pupil ; and both diminish 
the urinary secretion. They differ in some respects, but chiefly in the 
extent of their action, or quantitatively. Pilocarpine causes more 
perspiration and salivation ; muscarine produces decidedly more active 
intestinal movements. Pilocarpine diminishes the urinary secretion, 
but muscarine may arrest it entirely. Pilocarpine slightly contracts 
the pupil ; muscarine contracts the pupil more decidedly, but when 
applied to the eye directly, dilates the pupil. Pilocarpine always 
quickens the pulse, muscarine slows the pulse. 

Physiological Actions. — The salivary secretion in a large pro- 
portion of subjects is much increased. A feeling of constriction of 
the neck, nausea, and vomiting, and more or less abdominal pain, are 
produced by it, whether administered by the stomach or subcutane- 
ously (Brunton). The pancreatic and biliary secretions are notably in- 
creased after the injection of some milligrammes into a vein (Prevost). 
This increase of these secretions took place as well between as during 
digestion. The intestinal mucus is also greater in quantity than nor- 
mal, and it may be streaked with blood (Schiff). The intestines are 
thrown into active contractions, tetanized, rather than merely stimu- 
lated into more frequent vermicular movements. Under ordinary 
medicinal doses in man, the bowels are relaxed and the character of 
the evacuations altered, doubtless, because of the much greater quan- 
tity of the biliary and pancreatic secretions poured out. The increased 
movement of the intestines is accompanied by considerable colic-like 
pain. 

Muscarine enters the blood promptly, whether introduced through 



MUSCARINE. 671 

the stomach or subcutaneously. It is a cardiac poison. A very mi- 
nute quantity — a mere trace — applied to the frog's heart, arrests its 
movements. As Schmiedeberg and Koppe first demonstrated, it ar- 
rests the heart in the diastole, and does not impair the irritability of 
the heart-muscle, for, on irritation of the heart by mechanical, chemi- 
cal, or electrical means, it again contracts. If the dose is short of 
lethal, the heart is merely slowed, the number of pulsations being 
reduced ten, twenty, or even forty beats per minute. Section of the 
vagi does not affect this result. The action is due to stimulation of 
the intracardiac inhibitory apparatus. By Alison it is referred to over- 
excitation of the cardiac terminals of the vagus, and coincident dimi- 
nution in the activity of the sympathetic fibers. When the effects of 
muscarine are manifested by a diminution of the pulse-rate, the blood- 
pressure begins to decline. At first the vessels contract, but this is 
soon succeeded by dilatation (Bogosslowsky). With the slowing of 
the heart and dilatation of the vessels, the blood accumulates in the 
periphery, and the blood-pressure is consequently reduced one half. 

Disturbances of respiration occur with the other defined symptoms. 
The breathing grows more labored with the increasing effects of the 
agent, and presently an intense dyspnoea supervenes (Schmiedeberg). 
The mechanism of the labored respiration is obvious enough. Such a 
strong contraction of the pulmonary vessels ensues as to greatly di- 
minish the quantity of blood circulating in the lungs, with the result 
of over-distention of the right cavities of the heart. Hence it follows 
that the state of the blood is impaired by the lack of oxygen and the 
retention of carbonic acid, and to these factors must be attributed in 
part the cyanosis and asphyxia. These modifications of the respiration 
occur after preliminary section of the vagi. The almost arrested oxy- 
genation of the blood, the languid circulation, and the profuse perspi- 
ration, are the factors which cause a lowering of the temperature. By 
Schmiedeberg and Koppe there are recognized three conditions of the 
body-heat : 1. A slight elevation, which is by no means constant, and 
very transient, coming on in about two hours after the dose — a small 
one — has been taken ; 2. A depression of one or two degrees, suc- 
ceeded presently by the normal temperature, produced by a full medi- 
cinal dose ; and, 3. A very pronounced lowering of the temperature 
from a fatal dose. 

By the internal administration of muscarine the pupil contracts, and, 
singularly enough, by direct application, dilates. There are other ex- 
amples of this paradox. Vision is disturbed by alteration of the ac- 
commodation apparatus by spasm. The myosis depends on stimulation 
of the circular fibers of the iris or of the third nerve, and not on paral- 
ysis of the radiating fibers, or of the sympathetic filaments. 

Muscarine produces abundant perspiration, and, indeed, stimulates 
this function only less powerfully than pilocarpine. In most cases the 



672 MOTOR DEPRESSANTS. 

saliva is correspondingly increased. The two functions do not always 
act together with the maximum energy, and one may be powerfully 
affected, while the other is quiescent. Lachrymation is nearly con- 
stant, and the nasal mucus is more abundant than in the normal state. 
Thus, while all other secretions and excretions are increased by mus- 
carine, it is remarkable that the urine should be decidedly lessened in 
amount, even suppressed. In eight experiments made with great care, 
Prevost found that the injection of muscarine into a vein diminished 
the urinary secretion, and, indeed, almost stopped it when the dose 
was large. The elimination of muscarine takes place by the kidneys. 
The best evidence that it is excreted unchanged is the physiological 
action of the urine. The urinary secretion of an animal poisoned by 
muscarine will poison another animal to whom it is administered, and 
its powers are transmitted with little diminution through several. 

Therapy. — The applications of muscarine to the treatment of dis- 
ease are yet in their infancy. The physiological effects indicate the 
direction of the remedial applications. As muscarine stimulates so 
powerfully the muscular fiber of the intestine, and the secretions of 
the pancreas, liver, and intestinal mucous membrane, it ought to be 
very serviceable in cases of constipation with torpor of the organs 
concerned in digestion. When constipation is due to paresis of the 
muscular layer of the bowel and to deficient secretion, this remedy 
will probably relieve it. In the treatment of intestinal torpor and de- 
ficient secretion, muscarine may be combined with other remedies, as 
atropine and strychnine, which act on the organs concerned, or with 
cathartics and cholagogues : fy Muscarine, gr. iv ; ext. belladonna?, 
ext. nucis vomicae, aa gr. iij ; euonymin, 3 ss. M. Ft. pil. no. xij. 
Sig. : One pill morning and evening. When the digestion of the 
starches and fats is imperfect, it is strongly indicated. In catarrh of 
the duodenum, and in catarrhal jaundice, it ought to be very efficient. 
In these maladies, the remedy should be administered frequently and 
in small doses : 1} Muscarine, gr. j ; aquae, § j. M. Sig. : A tea- 
spoonful every three hours. It is probable, also, that it will prove 
useful in recent hemorrhoids due to congestion of the portal circulation. 
It promises well as a remedy for the removal of inflammatory effusions 
and exudations. It ought to afford prompt relief at the onset of a 
common cold, an acute bronchitis, hay-asthma, etc. As muscarine pro- 
duces strong contraction of the pulmonary capillaries, it ought to be 
useful in pulmonary hcemorrhage, in incipient congestion of the lungs^ 
etc. Under such circumstances the combination with digitalis ought 
to be especially effective, for, while digitalis will aid the curative ac- 
tion on the pulmonary vessels, it will, at the same time, antagonize 
the cardiac depression caused by muscarine. It is contraindicated in 
affections of the air-passages when secretion is in excess. For the 
night-sweats of phthisis fly-fungus has long been used, and a similar 



QUEBRACHO. 673 

fungus is commended by Trousseau ; but it has not been as success- 
ful in the hands of Murrell as some other agents, although capable, 
sometimes, of very good results. Muscarine is of doubtful propriety, 
if not positively contraindicated, in renal affections characterized by 
deficiency in the excretion. On the other hand, it ought to be of sig- 
nal service in diabetes insipidus and in saccharine diabetes. It has 
been used successfully to arrest the secretion of milk. 

Authorities referred to : 

Alison, Dr. Pouchardafs Annuaire de Therapeutique, etc., for 1877, p. 47 ; also, Gaz. 
Med. de Paris, February 20, 1877. The Action of Atropine and Muscarine on the Heart. 

Bogosslowsky, Dr. Centralblatt fur die med. Wissenschaften, No. 97, 1870. 

Brunton, T. Lauder. Journal of Anatomy and Physiology, 1876, p. 342. 

BTarnack, Dr. Erich. Archiv fur experimentelle Pathol, und Pharmakol., Band iv, 
p. 168. Untersuchungen uber Pfegenpilzalkaloide. 

Prevost, Dr. J. L. Pull. Gen. de Therap., vol. xciii, p. 371. Xote relative d V An- 
tagonisme mutuel de V Atropine et de la Muscarine. 

Ringer and Mosshead. Ringefs Hand-Pook of Therapeutics, eighth edition, article 
Muscarine. 

Schiff, Prof. Lo Sperimentale, abstracted in the London Medical Record, vol. iv, 
1876, p. 339. 

Schmiedeberg und Koppe. Das Muscarin, das giftige Alkaloid des Fliegenpilzes, etc. 
Leipsic, 1869. Vogel. 

Quebracho. — The bark of Aspidosperma quebracho, an apocynaceous 
tree of Chili. 

Peepaeations. — Tincture. — One part of quebracho to five parts of 
alcohol. Dose, ill v — 3 j. 

Wine. — One part of quebracho, two parts of alcohol, and sixteen 
parts of white wine. Dose, a teaspoonf ul to a tablespoonful. A fluid 
extract, prepared according to the general directions of the Pharma- 
copoeia, will probably be found an eligible preparation. 

Composition. — Quebracho seems peculiarly rich in alkaloids, but 
it is doubtful whether any one represents in its entirety the physio- 
logical powers of the bark itself. The most important are aspido- 
spermine, discovered by Fraude in 1878, and quebrachine, separated 
by Hesse in the following year. Hesse describes several other active 
constituents or alkaloids, but the two just mentioned are the most 
important. 

Adulteeations. — Soon after the first specimens were sent to 
Europe, the sudden demand which sprang up induced sophistication, 
and quebracho-wood and quebracho Colorado were substituted for the 
genuine. This substitution proved the less important, since these 
preparations acted in a similar manner, and were only weaker (Pen- 
zoldt). The early physiological investigations must, therefore, be in- 
terpreted by the light of this difference in the action of the several 
substances comprehended in the term quebracho. 
44 



074 MOTOR DEPRESSANTS. 

Physiological Actions. — Quebracho lias the stomachal effects of 
the bitters in general : it promotes appetite and increases the diges- 
tive powers. The alkaloids diffuse promptly into the blood. The 
action of the heart is lowered ; the pulse in the normal state is less 
frequent ; at first, the tone of the artery is higher and the blood-press- 
ure is raised, but as the action is continued, especially from lethal 
doses in animals, the force of the circulation declines and the pressure 
falls. The respiration is also slowed, and the sense of need of air is 
less imperative. The hurry of circulation and of respiration, and the 
feeling of oppression induced by active exercise, are modified by 
quebracho. Picot-Berthold studied these actions on his own person. 
Ascertaining first the rate of increase of the respiratory movements and 
of the circulation induced by active exercise of a definite amount, he 
next determined the influence of the remedy on these functions when 
the same amount of exercise had been taken. While without quebra- 
cho his pulse and respiration rose respectively to 42 and 94, under the 
action of the medicament they were 30 and 80. Not only was the 
rate of movement lessened, but the accompanying distress for want 
of air was decidedly ameliorated. 

Guttmann, who has made an elaborate study of aspido spermine, finds 
that in both cold- and warm-blooded animals it is an active poison 
of the respiratory and circulatory apparatus. In cold-blooded animals 
the respiratory actions are most pronounced, and death is produced 
by the effect of the poison on the respiratory center. Slowing of the 
heart's action proceeds pari passu with the diminution of the respira- 
tory energy, and the cessation of the heart's movements is finally due 
to the impression of the poison on the intra-cardiac motor ganglia. 
In warm-blooded animals (cats) the influence of the poison on the 
heart is primary. The slowing of the pulse is not due to any effect 
which it has on the vagi, but to the paralyzing action which it exerts 
on the cardiac motor ganglia. With the slowing of the heart the 
temperature declines, and, with the diminution of respiration, dyspnoea 
comes on. Then the accumulation of carbonic acid in the blood in- 
duces stupor, and in animals convulsions. The reflex function is low- 
ered in cold- but not in warm-blooded animals ; sensibility is unaf- 
fected in the latter, but motor paralysis finally occurs in both classes. 
Death is due to paralysis of the heart. 

Therapy. — The applications of quebracho in the treatment of dis- 
ease were originally empirical, but they are clearly deducible from its 
physiological actions. It has long been known as a fever-medicine 
and as a remedy for dyspnoea, in the province of Santiago, Chili, 
where it was first obtained by Dr. Schickendanz. It has been used 
as a stomachic tonic, like the bitters in general, but more especially 
like cinchona, to increase the appetite and digestion in atonic dys- 
pepsia. It is, however, chiefly important as a remedy for dyspnoea. 



QUEBRACHO. 675 

Picot, Skoda, Krauth, Penzoldt, and many others, have used it in va- 
rious instances of difficult breathing, with remarkable palliation. In 
emphysema, spasmodic asthma, urmmic asthma, in spasmodic cough, 
chronic bronchitis, with asthmatic breathing, it has afforded very con- 
siderable relief. It has appeared to be much less useful, if not injuri- 
ous, in the dyspnoea from valvular disease of the heart, and has had no 
effect in the dyspnoea of old subjects due to atheroma of the vessels. 
Krauth, however, has used it with advantage in the dyspnoea due to 
hypertrophy of the heart and in the difficulty of breathing in a case of 
albuminuria consecutive to scarlatina. The relief to dyspnoea in all 
cases, Penzoldt thinks, is referable to the increased consumption of 
oxygen by the blood, but a more rational explanation would seem to 
be the action on the respiratory center, and the diminution in the 
sense of need of air. 

Having a paralyzing action on the cardiac motor ganglia, quebracho 
is not without danger in cases of weak heart. It must be considered a 
doubtful remedy when the motor apparatus of the heart is impaired — 
especially, if the accelerator nerves and their terminal ganglia are the 
parts damaged. On the other hand, when the lesions of the heart are 
merely valvular, it would appear to be safe ; but in the dyspnoea due 
to this cause it is much less useful (Laquer, Berger). Certain unpleas- 
ant results of its administration render prolonged use of quebracho very 
difficult. These are, according to Laquer, headache, dullness of the 
sense-organs, vertigo, salivation, and a strong repugnance to its taste. 

The preparation most used at present is the extract, and the usual 
dose for an adult is five grains. The alkaloid aspido spermine has been 
administered chiefly in the experimental way, but, although its actions 
correspond closely to those of the bark itself, it can hardly represent 
the drug in its entirety, seeing that there are several alkaloids con- 
tained in it. The salts of aspidospermine — the citrate, hydrochlorate, 
and sulphate — are freely soluble in water, while the alkaloid itself is 
not at all readily soluble in water, but is taken up freely by oils and 
fats — five to eight parts dissolving in one hundred parts of cod-liver 
oil by heat. 

Authorities referred to : 

Berger, M. Pharm. Journ. and Trans., quoted by Annuaire de TMrapeutique for 
1881. 

Fraude, M. G. Quebracho- Aspidospermine. Bull, de la Soc. de Chim., quoted by An- 
nuaire de TMrapeutique for 1881. 

Guttmann, Dr. G. Ueber Wirkung und Amoendung verschiedener Aspidosperminprd- 
parate. Archiv fur experiment. Pathologie und Pharmakologie, Band xiv, p. 463. 

Krauth, Dr. ficorce de Quebracho, son emploi therapeutique. Bull. Gen. de Therapeii' 
tique, 1880. 

Penzoldt, Dr. F. Die Wirkungen Quebrachodogen, Erlangen, 1881. (Pamphlet.) 

Picot-Berthold. Quoted in Annuaire de Therapeutique for 1881. 

Skoda, Prof. Dr. Wiener med. Blatter, No. 41, 1879. 



6?6 EYACUANTS. 

REMEDIES USED TO MODIFY THE FUNCTIONS 
OF ORGANS {Continued). 

B.— OF THE GASTRO-INTESTINAL CANAL. 

EMETICS. 

Some of the agents in this group produce vomiting by virtue of a 
local action on the stomach, and do not affect this viscus when intro- 
duced elsewhere. These may be entitled Emetics by Local Action. 
There are others which cause emesis when they enter the blood at any 
point — Systemic Emetics. The first sub-group of emetics make an im- 
pression on the gastric nerves, and an action is at once instituted for 
their expulsion. The process consists in the transmission of the periph- 
eral irritation to the spinal center, the generation of a motor impulse, 
and the consequent action of the nervous and muscular apparatus 
concerned in the mechanism of vomiting. The systemic emetics pro- 
duce their effects through the intermediation of the blood, and the vom- 
iting is only one of the results of the disturbance introduced into the 
functions of the nervous system. 

EMETICS BY LOCAL ACTION. 

The most important of these are : 

Cupri sulphas, sulphate of copper. 

Zinci sulphas, sulphate of zinc. 

Hydrargyri sulphas flava, yellow subsulphate of mercury. 

Alumen, alum. 

Sinapis, mustard. 

Scilla, squill. 

All of the members of this group have been discussed in other parts 
of this work, except mustard and squill, and the consideration of these 
will be more appropriate elsewhere. It is necessary, however, in this 
place to indicate the nature of the action, the cases to which they are 
adapted, and the mode of administration of the more important of the 
emetics belonging to this division. 

Cupri Sulphas. — This is a very prompt and efficient emetic. The 
action begins in a few minutes, and the medicine comes up with the 
vomited matters. Very little depression follows the emetic action. It 
is more especially adapted to the treatment of narcotic poisoning, be- 
cause, the action being local, the obtunded state of the reflex centers 
interferes less with its operation than is the case with the systemic 
emetics ; and to phosphorus poisoning ', because of its antidotal power. 
It is also occasionally used in croup, to effect the dislodgment of the 
false membrane, but other mechanical emetics are preferable. 

Administration. — Dissolve twenty grains of the sulphate of copper 
in two ounces of distilled water, and give a tablespoonful every fifteen 



EMETICS. 677 

minutes until vomiting occurs. When prompt action is required, as in 
narcotic poisoning, ten grains of the sulphate of copper may be given 
at a draught in an ounce or two of water. Its action should be assisted 
by the free use of diluents. 

Zinci Sulphas. — This agent acts in a manner similar to the corre- 
sponding copper-salt, but is less powerful. It has the advantage of be- 
ing less likely to induce gastro-enteritis than sulphate of copper, and 
is, therefore, usually preferred to the latter. It is administered in cases 
of narcotic poisoning, in croup, and to relieve the stomach of indi- 
gestible alimentary substances. 

Administration. — In narcotic poisoning a scruple of the sulphate 
of zinc may be administered in water, and, if need be, repeated once. 
In croup, or for other purposes, as an emetic, it may be given as fol- 
lows : Dissolve a half -drachm in two ounces of water, and administer a 
tablespoonf ul every fifteen minutes until emesis is produced. The free 
use of diluents promotes the emetic action. 

Hydrargyri Sulphas Flava. — This is one of the most efficient mem- 
bers of this group. It is an active poison, but, as it is returned with 
the contents of the stomach, no danger attends its administration. It 
does not act so speedily as copper and zinc. It produces very little 
nausea, but, when the action begins, the effects are suddenly experi- 
enced, and are powerful, without leaving after-depression and sickness. 
It is not so well adapted to the treatment of narcotic poisoning as the 
copper and zinc sulphates, but it is the most desirable emetic in the 
treatment of croup. It was formerly much prescribed in this disease 
as an emetic, but it fell out of fashion until revived recently by Dr. 
Fordyce Barker. The author's experience in its use is, in the main, 
in accord with the much more extended experience of Dr. Barker. 

Administration. — As the yellow subsulphate of mercury has but 
little taste, it is easily administered to children. It should be prescribed 
in the form of powder, rubbed up with sugar of milk. The dose varies- 
from two to five grains. Dr. Barker makes the useful suggestion that 
powders of this preparation, labeled " croup-powders," should be kept 
in every household, the children of which have a tendency to attacks 
of croup. It should be given when the first symptoms manifest them- 
selves, and its repetition will be governed by the state of the breathing. 

Alumen. — Powdered alum is a safe, efficient, but slow emetic. 
About a half -hour usually elapses after it is swallowed before the eme- 
sis occurs. It acts mechanically, produces no considerable nausea, and 
leaves behind no depression. As an emetic, its only use is in croup and 
diphtheria, administered with the view to cause a detachment of the 
false membrane. Some effect has been ascribed to the local action of 



tf$ EVACUANTS. 

the alum in its passage along the throat, but this opinion is scarcely 
tenable. 

Administration. — A teaspoonful of powdered alum may be ad- 
ministered in sirup, honey, or mucilage. It can be repeated, if need 
be, every half -hour. 

Sinapis. — Mustard is a stimulant, local emetic. It acts promptly 
and efficiently. In emergencies, other emetics not being available, it 
may be employed in narcotic and other forms of poisoning. As an 
emetic it is especially adapted to depressed conditions of the system — 
for, while it causes vomiting, it stimulates the action of the heart. 
When, therefore, an emetic is indicated, and at the same time the cir- 
culation is feeble, the surface cold, and the functions of animal life 
oppressed, mustard should be used. 

Administration. — A tea- to a dessert-spoonful of powdered mus- 
tard should be stirred up in a tumblerful of tepid water, and quickly 
swallowed. The irritant action of the mustard may be limited, and its 
emetic action promoted, by the free use of diluents. 

Scilla. — Squill is never employed as an emetic by and of itself. It 
is harsh and rather slow in action. In the form of the compound sirup 
of squills, it is not unfrequently used for this purpose, especially in 
domestic practice, but the emetic property of this combination is due 
chiefly to the tartar-emetic which it contains. 

SYSTEMIC EMETICS. 

Apomorphine. — Apomorphinoz Hydrochloras. — Hydrochl orate of 
apomorphine. The hydrochlorate of an artificial alkaloid obtained by 
the action of strong acids upon morphine contained in closed tubes and 
subjected to a somewhat elevated temperature. It is obtained also by 
the action of chloride of zinc in solution on morphine. It is a whitish 
powder, which becomes greenish by absorption of moisture. It is solu- 
ble in water, and it may, therefore, be administered in this menstruum. 
Dose, gr. -fj to gr. -J. If given hypodermatically, gr. -^ is sufficient ; 
if by the stomach, gr. J. As it undergoes important changes when in 
contact with water, the solution for hypodermatic use should be made 
when required, or at least should be frequently renewed. 

Physiological Actions. — Whether injected under the skin or 
taken into the stomach, apomorphine causes vomiting. The rate at 
which it moves to affect the stomach depends somewhat on the dose 
administered. From five to twenty minutes elapse after the hypo- 
dermatic injection before vomiting begins. The act of vomiting is pre- 
ceded by very little nausea, the contents of the stomach are usually 
thoroughly evacuated, and the vomiting recurs a few times at inter- 
vals of a quarter to a half hour. In young subjects very considerable 



SYSTEMIC EMETICS. 679 

depression has been observed to be produced by it, and dangerous 
symptoms of cardiac paralysis have followed its emetic action in a few 
instances. These clinical facts seem to contradict the experimental 
observations of Siebert and Moerz, who have shown that apomorphine 
does not affect the blood-pressure, and that the pulse rises when emesis 
comes on, reaches its maximum during vomiting, and declines m the 
interval. The cardiac depression which has been observed, clinically, 
may have been the result of idiosyncrasy, yet we should not lose sight 
of the fact observed by Harnack, that in cold-blooded animals it may 
be produced experimentally. 

Apomorphine causes at first increased rapidity of the respiration, 
afterward diminishes the force and depth of the movements, and 
finally arrests them. As this result occurs when the vagi are divided, 
the drug must necessarily first excite and afterward exhaust the irrita- 
bility of the respiratory center. Apomorphine has no appreciable in- 
fluence on the temperature. 

As respects its impression on the nervous system, apomorphine is 
at first strongly excitant. Afterward it causes muscular tremblings, 
followed by paralysis and convulsions. The muscular irritability is 
impaired but not destroyed, and the functions of motor and sensory 
nerves remain intact ; hence it may be concluded that the convulsant 
action of this agent is due to a direct impression on the spinal cord 
(the spasm-center). 

Therapy. — Apomorphine is indicated as an emetic when swallow- 
ing is difficult or impossible, and when very prompt action is neces- 
sary. As it produces vomiting by its spinal action, profound narcosis 
will prevent it, and hence, in narcotic poisoning, it may fail of effect 
unless administered before narcosis has supervened. It is a suitable 
emetic when it is desired to empty promptly an overloaded stomach. 
It is to be preferred to all emetics which must be introduced into the 
stomach, when this viscus is in a state of inflammation, for it is best 
given subcutaneously. Apomorphine has been administered as an 
emetic in suffocative catarrh, to empty mechanically the bronchial 
tubes, but it produced serious depression — a result which might have 
been a priori predicted, since this drug exerts a paralyzing action on 
the respiratory organs. It has also been given as an expectorant, but 
on insufficient data, for it does not seem to have an effect upon the 
vagi, and, as above stated, at first it excites the respiration movements, 
and afterward paralyzes them. 

As compared with its congeners, morphine and codeine, it is more 
excitant than morphine and codeine, and without their hypnotic and 
anodyne properties. As respects its convulsant action in animals, it 
has close physiological relations to narcotine and thebaine. Some clini- 
cal experiences have shown (Riegel und Bohm) that apomorphine 
causes heaviness in the head, giddiness, drowsiness, yawning, mental 



6SC EVACUANTS. 

hebetude, etc. The trials in which these results were noted were made 
with Merck's preparation of apomorphine. 

Authorities referred to : 

Gee, Dr. Samuel. Note upon Apomorphia and Chlorocodide. St. Bartholomew's Hos- 
pital Reports, vol. v, 1869. 

Harnack, Dr. E. Arch./, experimented Pathologie und Pharmakologie, vol. ii, p. 291. 

Hermann, Dr. L. Lehrbuch der experimentellen Toxicologic, p. 381. 

Husemann, Dr. Theod. Handbnch, etc., zweiter Band, p. 615. 

Moerz, Dr. A. Prag. Vjhrsbr., 76, 1872. Abstracted in Schmidt's Jahrbucher, vol. 
clvii, p. 12. 

Quehl, Dr. Max. TJeber die phys. Wirkungen des Apomorphia. Schmidt's Jahr- 
biicher, vol. civ, p. 14, et seq. 

Riegel und Bohm. Arch. f. klin. Med., vol. ix, 2, p. 211, 1871. 

Siebert, Dr. Vincent. Untersuchungen uber die physiol. Wirkungen des Apomorphin. 
Abstracted in Schmidt's Jahrbucher, vol. civ, p. 14, et seq. 

Ipecacuanha. — Ipecacuanha. The root of Cephaelis ipecacuanha 
A. Richard (Nat. Ord. Bubiacete). (IT. S. P.) Racine $ ipecacuanha, 
Fr. ; Brechvmrzel, Ger. 

Extractum Ipecacuanhas, Fluidum. — Fluid extract of ipecacuanha. 
Dose, Hi ij — 3 j. 

Syrupus Ipecacuanhas. — Sirup of ipecacuanha (fluid extract, § ij ; 
sirup, I xxx). Dose, 3 j — f ss. 

Tinctura Ipecacuanha} et Opii. — (Deodorized tincture of opium 
and fluid extract of ipecac.) Dose, r\ v — t\[ xv. A liquid equivalent 
of Dover's powder. 

Trochisci Ipecacuanhas. — Troches of ipecacuanha (ipecac, traga- 
canth, arrow-root, sugar, and sirup of orange-peel). Dose, one or 
more. Each troche contains one fourth of a grain of ipecacuanha. 

Trochisci Morphinas et Ipecacuanha. — Troches of morphine and 
ipecacuanha (each troche contains one fortieth of a grain of morphine, 
and one twelfth of a grain of ipecac). 

Vinum Ipecacuanhce. — Wine of ipecacuanha (fluid extract of ipe- 
cac, 1 ij ; sherry wine, § xxx). Dose, m, j — 3 j. 

Pulvis Ipecacuanhas et Opii. — Compound powder of ipecacuan- 
ha. Dover's powder. Ten grains contain one grain each of ipecac 
and opium, and eight grains of sugar of milk. This preparation has 
already been discussed in the article on opium, and requires no con- 
sideration here. 

Composition. — Ipecacuanha contains an active principle, designated 
emetina or emetine. This exists in the bark of the root, in combina- 
tion with a peculiar acid — ipecacuanhic acid. The alkaloid is found 
in the root in a proportion somewhat less than one per cent. It is a 
bitter, inodorous, and amorphous substance, colorless, and alkaline in 
reaction. It is freely soluble in chloroform, and only slightly so in 
ether. Ipecacuanhic acid is a glucoside, and is chemically related to 
kinic and caffetannic acids. 



SYSTEMIC EMETICS. 681 

Antagonists and Incompatibles. — The salts of lead and mer- 
cury, the vegetable acids, and astringent infusions, are incompatible. 
The tannate of emetine is extremely insoluble. Bismuth, carbolic acid, 
hydrocyanic acid, and narcotics generally, hinder its emetic action. 

Synergists. — The emetics — those by local action and the systemic 
— favor the vomitive action of ipecac. Its effects on the skin and bron- 
chial mucous membrane are promoted by opium, warm diluents, etc. 

Physiological Actions. — Inunctions of ipecacuanha excite very 
considerable irritation of the skin : at first, small, isolated pustules ap- 
pear, and these are followed by large pustules and ulceration (Duck- 
worth). When applied to the mucous membrane of the nares, it pro- 
duces a sensation of heat, and causes sneezing. Some persons are so 
susceptible to its action that the smallest quantity inhaled will induce 
an asthmatic paroxysm. 

Administered by the stomach in small doses (from one eighth to 
one quarter of a grain), ipecacuanha acts as a stomachic tonic, and 
probably increases the gastric secretions. In larger doses (from five 
grains to a scruple), it is nauseant and emetic ; but the sickness which 
it causes is not severe, and the vomiting is not accompanied nor fol- 
lowed by much depression. Its action as an emetic is rather slow, 
from twenty minutes to a half -hour being required, and is not per- 
sistent. Repetition of large doses will, in most cases, but not invari- 
ably, produce a condition of tolerance, when vomiting does not occur, 
but a cathartic action is induced, the stools having a peculiar bilious 
character, appropriately designated " ipecacuanha-stools." Both vomit- 
ing and purging are sometimes produced by an emetic of ipecacuanha. 

Like other nauseants and emetics, ipecac increases the secretions of 
the broncho-pulmonary mucous membrane, and is, therefore, held to 
possess expectorant properties. More than any other agent of the class, 
it relaxes the skin, and promotes cutaneous transpiration. 

Ipecacuanha exerts but little influence over the circulation. In ani- 
mals, lethal doses of emetine cause death by paralysis of the muscles 
of respiration, the heart continuing in action after the cessation of the 
respiratory movements (D'Ornellas). The temperature of the surface 
falls, but the internal temperature remains the same, or rises somewhat, 
owing, it is said (D'Ornellas), to the irritant action of the agent on the 
intestinal mucous membrane. 

In the post-mortem examination of animals killed by emetine, very 
considerable gastro-intestinal irritation is found. The lungs are some- 
times seen to be hypersemic and presenting patches of hepatization, 
and sometimes exsanguine, but the former condition is more frequently 
observed. As the most common state of the lungs, caused by lethal 
doses of ipecac, is similar to that which is induced by section of the 
vagi, it is a reasonable conjecture that it has a special action on these 
nerves — according to Chpuppe, on the terminal filaments of the vagi. 



682 EVACUANTS. 

The elimination of emetine takes place in large part by the gastro- 
intestinal mucous membrane, and it is found in the secretions. 

Therapy. — For ordinary purposes no emetic is more safe and effi- 
cient than ipecacuanha. As it causes but little depression, and is free 
from irritant effects in ordinary doses, it may be given in conditions of 
the system in which tartar-emetic and the other mineral emetics are 
inadmissible. When the stomach is to be relieved of undigested ali- 
ment, ipecacuanha is the most suitable emetic. Attacks of acute indi- 
gestion, migraine, and the so-called bilious sick- headache, may not un- 
frequently be cut short by an ipecac-vomit. The good effects of the 
vomitive treatment are, not unfrequently, most strikingly exhibited 
in the beginning of continued fevers, the eruptive fevers, erysipelas, 
and periodical fevers. It has been alleged that fevers are sometimes 
" aborted " in this way. In denying the possibility of such results, it 
must be admitted that clinical experience has shown the good effects 
of the practice on the subsequent course of the malady. Formerly 
an ipecacuanha- emetic was much more frequently emplyed at the out- 
set of fevers than is the fashion at present, and the author is con- 
vinced that this mode of treatment should be resorted to now in suit- 
able cases. The indications for the use of emetic doses of ipecac- 
uanha, in the fevers above named, are these : a heavily-coated tongue, 
much nausea and ineffectual efforts to vomit, a strong sense of epigas- 
tric oppression, icterus or an icterode hue of the surface, a hot and dry 
skin, acid and turbid urine. When these symptoms are present in 
cases of malar icd fever, the antiperiodic remedies will be much more 
effective in their action if their administration has been preceded by 
an ipecacuanha-emetic. 

In all the cases in which emetics are employed for mechanical effects, 
as in membranous croup, capillary bronchitis, foreign bodies lodged, 
etc., ipecacuanha may be used. In croup it is not so effective as the 
yellow subsulphate of mercury ; in capillary bronchitis, as tartar-emetic; 
but, as respects the latter disease, ipecacuanha is to be preferred in the 
very young or very old, and in those debilitated by any cause. In the 
domestic treatment of laryngismus stridulus an emetic dose of the 
sirup of ipecac is the most usual remedy. 

As an emetic, twenty grains of the powder of ipecacuanha may be 
diffused in a cup of warm water, and a tablespoonful of the mixture 
exhibited every fifteen minutes until emesis occurs. Two grains may 
cause vomiting ; and four grains will usually act efficiently ; hence a 
good method of proceeding, when an emetic effect is desired, is to ex- 
hibit a powder of four grains in a tablespoonful of warm water every 
fifteen minutes until vomiting occurs. The action will be facilitated 
by drinking freely of warm water ; but, if the systemic impression of 
the ipecacuanha is desired, the patient should retain the recumbent post- 
ure, and all fluids should be withheld. If the cathartic as well as the 



SYSTEMIC EMETICS. 683 

emetic action is sought for, some weak animal broth should be given 
when the stomach is emptied of its contents. If free action of the 
skin is to be promoted, as soon as the vomiting has ceased, warm 
aromatic infusions should be administered, and the patient should be 
covered with blankets. 

It has long been known that ipecacuanha, in small doses, has the 
power to arrest certain kinds of vomiting. Attention has recently been 
recalled to this curious fact. It is in nervous vomiting more especially 
that this remedy is useful : for example, in the vomiting of pregnancy, 
vomiting of drunkards, vomiting of migraine, etc. A minim of the 
vinum ipecacuanhas, given every half -hour or hour in a little water, will 
sometimes relieve these cases in a very remarkable manner. It fails 
much more often than it succeeds, and the author has never yet seen 
an instance of its successful use in this way. The belief in this 
action is largely traditional — even apocryphal. 

It is a singular fact, showing the remarkable phases through which 
professional opinion passes, that ipecacuanha, which was introduced at 
the close of the seventeenth century as a remedy for dysentery, after a 
time ceased to be employed in this disease, but has again been restored 
to the estimation in which it was originally held. Epidemic dysentery, 
especially of malarious and tropical countries, is the form of the disease 
to the cure of which ipecacuanha seems best adapted. The author has 
used it with much success in acute dysentery, as it occurs in the interior 
valley of this continent. When the characteristic ipecacuanha-stools 
are produced, the tormina and tenesmus cease, and the dejections soon 
become fecal ; the skin, previously dry and hot, becomes moist and 
cool, and a refreshing calm is experienced. Large doses of ipecacuanha 
are required in the treatment of acute dysentery. In the severe attacks 
of tropical regions, from twenty to sixty grains are given for the initial 
dose, and the quantity subsequently administered depends on the effect 
— usually about twenty grains every four, six, or eight hours. It is 
important to establish tolerance of the remedy as speedily as possible. 
If the first dose be rejected, subsequent ones may be retained. Various 
expedients may be resorted to in order to secure the retention of these 
large doses. The ipecacuanha may be combined with some opium and 
aromatic powder : r> Ipecacuanhae, 3 ss ; opium, gr. j ; pulv. aromat., 
grs. v. M., ft. pulv. no. j. After the dose of ipecacuanha is adminis- 
tered, a sinapism may be applied to the epigastrium, and an enema of 
laudanum and starch, or the subcutaneous injection of morphine, may 
be practiced. Milk is an excellent vehicle for the administration of ipe- 
cacuanha. In the cases of dysentery treated on this plan by the author, 
he has found that doses of fifteen grains, given in milk, were generally 
pretty well borne. It not unfrequently happens, however, that toler- 
ance can not be established, and the remedy must then be abandoned. 
Some patients so object to the nausea produced by it as to be reluctant 



684 EVACUANTS. 

to take it, and others, after one trial, decline to continue the treatment. 
Notwithstanding these drawbacks, it must be conceded that ipecacu- 
anha is a most valuable remedy in epidemic and sporadic dysentery. 
It has been shown that in India, before the introduction of this 
method of treatment, the mortality from dysentery was about 79*6 
per one thousand of cases ; but, since the use of ipecacuanha has 
been generalized, the mortality has fallen to 20*15 per one thousand 
of cases. 

Ipecacuanha has also been used with success in chronic dysentery, 
but, in the author's experience, it is by no means so beneficial as in the 
acute. It succeeds best in those cases which are the outgrowth of acute 
attacks, and in which the intestinal ulcerations are not far advanced. 
The rules for its administration are the same in chronic as in acute dys- 
entery. In the summer dysentery and diarrhoea of teething children 
ipecacuanha is often extremely serviceable. The special indication for 
its use is the occurrence of greenish stools, containing mucus and some- 
times blood. These stools are usually voided with much pain and 
straining. At the same time the skin is harsh and dry, the tongue 
rather dry and pasty, or glazed, and there is great thirst, although the 
fever may not be high. Ipecacuanha changes the character of the 
stools, induces perspiration, and allays the thirst and dryness of the 
mouth. From two to five grains every two hours may be given in these 
cases, or it may be administered with pepsin, oxide of zinc, bismuth, 
or other remedies. I£ Ipecacuanha?, grs. xij; bismuthi subcarb., 3 j ; 
pepsinae sacch., 3 ss. M., ft., pulv. no. xij. Sig. : One in milk every 
two hours. 

The evidence is conclusive that ipecacuanha possesses very valuable 
antihaemorrhagic powers. It has been successful in haemoptysis, epis- 
taxis, menorrhagia, post-partum hemorrhage, etc. As Peter has ob- 
served, " the vomitive medication " (ipecacuanha) " arrests not only 
haemoptysis but all kinds of haemorrhage, and is, therefore, a general 
antihaemorrhagic medication." In haemorrhages the ipecacuanha should 
be given in frequently-repeated doses until vomiting ensues ; usually, 
when this effect is produced the haemorrhage ceases. Other antihaem- 
orrhagic agents may be combined with ipecacuanha. 3 Ext. ipecac, 
fluidi, 3 ij : ext. ergotae fluidi, 3 iv ; ext. digitalis fluidi, 3 ij. M. 
Sig. : Thirty minims to a teaspoonfid at a dose, as required. The 
author has witnessed excellent results from this combination in hae- 
moptysis and menorrhagia. In the treatment of post-partum haemor- 
rhage, the most suitable combination is fluid extract of ipecacuanha 
and fluid extract of ergot. Trousseau strongly urges the employment 
of ipecacuanha in post-partum haemorrhage, and, indeed, in the various 
accidents which occur in the puerperal state, and, above all others, as 
respects the utility of the treatment — puerperal dysentery — in which 
the author has verified Trousseau's statements. " He has not observed 



SYSTEMIC EMETICS. 685 

the least ill-result from this practice ; on the contrary, in the most of 
these cases, he has obtained either a cure or a notable amendment." 

Certain acute affections of the broncho-pulmonary mucous mem- 
brane are much benefited by non-emetic doses of ipecacuanha ; for 
example, acute catarrh of the nasal and bronchial mucous membrane, 
hay-asthma, capillary bronchitis. An emetic dose will cut short an 
attack of laryngismus stridulus. An occasional emetic gives great 
relief in whooping-cough, when there is profuse bronchial secretion. 
Non-emetic doses of the fluid extract (t^ j — ttj, iij) diminish the violence 
of the spasms in this disease. Nauseating and emetic doses are ser- 
viceable in the attacks of spasmodic asthma, but the good effects of the 
remedy are lost by repetition. Ordinary colds, especially in children, 
are benefited by doses sufficient to produce slight nausea but not vomit- 
ing. A troublesome cough at night, which prevents sleep, may not 
unfrequently be arrested by a dose at bed-hour of some one of the 
ipecacuanha preparations. For these various purposes the wine or the 
fluid extract may be used, but the latter preparation is much more 
trustworthy and effective than the former, if genuine. 

Authorities referred to : 

Chouppe, M. Archives de Physiologic, No. 1, 18*75, p. 101. 

D'Ornellas, Dr. Antonio-Evaristo. Du Vomissement, etc. Bulletin Gen. de Therap., 
vol. lxxxiv, pp. 193, 244, 295, 348. 

Duckworth, Dr. Dtce. St. Bartholomew's Hospital Reports, vol. v, p. 287, 1869. 

Fluckiger and Hanbury. Pharmacographia, article Ipecacuanha. 

Fuller, C. C. London Lancet, December 4, 1869. On the Action of Ipecacuanha. 

Husemann, Dr. Theodor. Handbuch der gesammten Arzneimittellehre, zweiter Band } 
p. 608, et seg. 

Peter, M. Michel. A propos des Hemoptysies et de leur Traitement par la Medication 
Vomitive. Bulletin Gen. Therap., vol. lxxvii. 

Phillips, Dr. C. D. F. On the Actions and Uses of Ipecacuanha. The Practitioner, 
vol. iii, p. 2*76, et seq. 

Ibid. Materia Medica and Tlierapeutics, article Ipecacuanha. 

Ringer, Dr. Sydney. Handbook of Tlierapeutics. 

Trousseau et Pidoux. Trait'e de Therapeutique et Mat. Med., huitieme edition, vol. 
i, p. 733, et seq. 

Antimonii et Potassii Tartras. — Tartrate of Antimony and JPo- 
tassa. — Tartar-emetic. 

This is a powerfully spoliative and depressing emetic, which has 
already been discussed under the head of " Agents promoting Destruc- 
tive Metamorphosis." It was formerly much employed as an emetic 
in croup, capillary bronchitis, and at the onset of fevers and inflamma- 
tions ; but the local irritation, as well as the systemic depression which 
follows, has led to its almost entire disuse for these purposes ; but, in 
the author's judgment, not wisely in toto. 

Administration. — Six grains may be dissolved in four ounces of 
water, and a tablespoonful be given every fifteen minutes until emesis 



686 EVACUANTS. 

occurs. Ipecacuanha and tartar-emetic are frequently administered 
together — twenty grains of the former and two grains of the latter. 

CATHARTICS. 

Purgatives are divisible into several groups, according to the nature 
of their action. 

Laxatives are medicines which stimulate the intestinal movements, 
without increasing to any considerable extent, at least, the intestinal 
secretions. 

Saline Purgatives excite increased secretion, while at the same 
time they hasten the peristaltic action. The dejections which are 
produced by them are loose and watery. 

Mercurial Purgatives^ chiefly calomel and blue mass, exert an in- 
fluence peculiar to themselves. Without expressing an opinion at 
present, for or against their supposed cholagogue effects, the author 
believes that they differ so much in their action from other purgatives 
as to be appropriately placed in a separate class. 

Tonic-astringent and Pesin-bearing Purgatives. — These affect the 
liver and the glandular appendages of the mucous membrane, and in- 
crease the tonicity of the muscular layer of the intestine. They in- 
crease the proper secretion of the glands, and do not merely cause an 
outward diffusion from the vessels into the canal. 

Hydragogue Purgatives act with great energy, and not only in- 
crease the glandular secretions, but cause a very abundant outward 
diffusion, so that the dejections which they produce are extremely 
watery. This group of purgatives also excite very rapid and violent 
peristaltic movements. 

Laxatives. — Manna. — Manna. The concrete, saccharine exudation, 
in flakes, of Fraxinus omus Linne (Nat. Ord. Oleacem). Dose, 3 j — 
| ij, according to age. 

Composition and Properties. — Manna has a sweetish, rather 
mawkish taste ; is soluble, when pure, in three parts of cold water, and 
in its own weight of boiling water. It contains a sugar — manna- 
sugar or mannite, which constitutes from seventy to eighty per cent 
of the best specimens of manna. It is said to contain dextrin, or a 
mucilage having similar reactions, and ether extracts from it in small 
quantity a slightly acrid, reddish-brown resin, on which the laxative 
property of manna probably depends. 

Actions and Uses. — Manna is a very mild laxative, but, when 
administered alone, is apt to cause griping. It is rather slow in its 
operation, but is free from irritating qualities, and leaves no unpleas- 
ant after-effects. It is most frequently combined with other purga- 
tives — senna chiefly — the operation of which it aids, and at the same 
time renders less drastic. It is rarely given alone, and only to chil* 



CATHARTICS. 687 

dren and pregnant women. Formerly it was used as a laxative in 
hemorrhoidal affections. 

Sulphur. — Sulphur lotum (washed sulphur). Sulphur sublimatum 
(sublimed sulphur). Washed sulphur only should be used as a laxa- 
tive. Sublimed sulphur contains a trace of acid which imparts to it a 
griping quality. Dose, 3 j — 3 iij. 

Actions and Uses. — Sulphur is insoluble in water, but dissolves in 
alkaline solutions and in the volatile and fixed oils. In the small in- 
testine, sulphur is placed under favorable conditions for absorption. 
That it does enter the blood is proved by the fact that it appears in 
the perspiration, urine, milk, etc. Silver coins, carried in the pockets 
of those taking sulphur, are discolored by the formation of the sul- 
phide of silver. Considerable sulphureted-hydrogen gas is produced 
as a result of the chemical changes in the intestines, and a quantity of 
offensive flatus is an unpleasant sequel of its administration. The in- 
testinal secretions are somewhat increased by it, and the stools are 
therefore softer. It is a very mild laxative. Combination of sulphur 
and bitartrate of potassa or magnesia is occasionally resorted to, es- 
pecially in domestic practice, for the purpose of increasing the laxative 
action. 

Sufficient attention has already been paid to the sulphur compounds, 
and it only now remains to speak of sulphur as a laxative. It is used 
chiefly to render the stools softer and more easily voided in cases of 
hemorrhoids, fissures of the anus, and after surgical operations about 
the pelvic organs. It is used also as a laxative in skin-diseases, chronic 
rheumatism, sciatica, and lead-cachexia, conjoined usually with sul- 
phur-baths, the sulphurous mineral waters, and other appropriate med- 
ication. 

Pulvis Glycyrrhiz^e Compositus is an efficient laxative. It is 
made as follows : Senna-leaves, eighteen parts ; licorice-root, sixteen 
parts ; fennel-seeds, eight parts ; washed sulphur, eight parts ; re- 
fined sugar, fifty parts. M. Sig. : A teaspoonf ul at a dose. 

Magnesia. — Magnesia. — Light magnesia. A white, very light and 
very fine powder, slowly absorbing carbonic acid from the air, odorless, 
having an earthy but no saline taste, and a faintly alkaline reaction 
when moistened with water. It is almost insoluble in water, or in alco- 
hol, etc. Dose, 3 ss — 3 ij, or more. 

Magnesia Ponder osa. — Heavy magnesia. A white, dense, and 
very fine powder, corresponding in all other properties to the above. 
Dose, 3 ss — 3 ij. 

Magnesii Carbonas. — Carbonate of magnesia. Light, white, fria- 
ble masses, or a light, white powder, odorless and tasteless, insoluble 
in alcohol, and almost insoluble in water. Dose, 3 ss — 3 ij. 



688 EVACUANTS. 

Mistura Magyiesiai et Asafcetidce. — Mixture of magnesia and asa- 
fcetida. (Carbonate of magnesium, five parts ; tincture of asafoetida, 
seven parts ; tincture of opium, one part ; sugar, ten parts ; and" suffi- 
cient distilled water to make up one hundred parts. Dewees's for- 
mula.) Dose, one fourth to one teaspoonful. 

Actions and Uses. — A mild antacid laxative. In the stomach it 
neutralizes any free acid it meets with, and the resulting salt has a 
laxative action. It is used to correct acidity, the carbonate being pre- 
ferred when there is an irritable state of the stomach, because the 
carbonic acid, which is set free by the action of the stomach acid, is a 
local sedative and anodyne. If magnesia does not enter into combi- 
nation with the stomach acid, no laxative effect is produced. Under 
these circumstances a solution of citric acid or lemonade, taken after 
the magnesia, will cause it to act. Magnesia is a useful antacid and 
laxative in sick-headache, especially when accompanied by acidity and 
constipation. It has been employed also in gouty affections, and in 
lithiasis (uric acid) ; but it is much inferior to the potash salts in 
these affections. In the intestinal indigestion of infants, attended 
with flatulence, magnesia is much prescribed in conjunction with car- 
minatives. Dewees's formula io\ flatident colic and diarrhoea in in- 
fants has been made official, and is given above as Mistura Magnesia? 
et Asafwtidm. The carminative of Dalby is similar in composition : 1} 
Magnesii carbonat, 3ij ; ol. menth. pip., gt. j ; ol. myrist., gtt. ij ; ol. 
anisi, gtt. iij ; tinct. castor., gtt. xxx ; tinct. asafoetid., gtt. xv ; tinct. 
ol. hedeomae, gtt. xv ; tinct. cardam. comp., gtt. xxx ; aquae menthae 
pip., f ij. M. Sig. : A teaspoonful, as necessary. 

Magnesia is frequently combined with other purgatives because of 
its antacid property. The following is Meigs's formula, gelsemium 
having been substituted for henbane : 1} Magnesii carb., 3 ss ; mag- 
nesii sulphat., 3 iij ; spts. ammonia? aromat., 3 j ; tinct. rhei, 1 ss ; tinct. 
gelsemii, 3 ss ; aquae menthae pip., § iv. M. Sig. : A tablespoonful 
two or three times a day. 

It is unsafe to use magnesia in large quantity for lengthened 
periods, owing to the fact that it may form intestinal concretions 
— a hydrate of magnesia. Instances of this kind have been re- 
ported. 

Freshly-precipitated hydrate of magnesia is an antidote to arseni- 
ous acid in solution, but it is not so effective as the hydrated sesqui- 
oxide of iron. 

Fel Bovis. — Ox- gall. — The fresh gail of Bos Taurus Linne (class 
Mammalia ; order, Ruminantia). 

Description. — A brownish-green or dark-green, somewhat viscid 
liquid, having a peculiar odor, a disagreeable, bitter taste, and a neu- 
tral or faintly alkaline reaction. 



CATHARTICS. 689 

Fel Bo vis Inspissatum. — Inspissated Ox-gall — Evaporated in a 
porcelain capsule to the proper consistence for pillular mass. Dose, 
gr. x - 3 ij. 

Fel Bovis Purificatum. — Purified Ox-gall. — Fresh ox-gall precipi- 
tated by alcohol and evaporated to the proper consistence for a pill- 
mass. Dose, gr. x — 3 j. 

Actions and Uses. — The above-mentioned preparations of ox-gall 
have a liquefying effect on the bile ; they increase the duodenal secre- 
tions, emulsionize fats, and quicken the peristalsis of the intestines. 
Hence, they are laxative. Ox-gall has been given with some success 
in those disorders of the intestinal canal characterized by the absence 
of some secretions, and the diminution of others, by foul odor of the 
stools due to decomposition, and in jaundice, when the bile is retained 
in the liver because of inspissated masses that block the common duct, 
or of mucus that has had the same effect. 

Cascara Sagrada. — (Not official.) The bark of Ehamnus Purshiana. 

Composition and Preparations. — The most important constitu- 
ent is chrysophanic acid. The fluid extract is the most convenient 
preparation. The dose of this is v\ x — 3 j or 3 ij. 

Action and Uses. — Under the name cascara sagrada (sacred bark) 
it has long been used in California as a cathartic. Besides this action, 
extraordinary qualities have been attributed to it. The taste is bitter, 
and it has some of the properties of substances of that kind, having 
the effects of a stomachic tonic. It improves appetite and digestion, 
and increases the secretions of the gastro-intestinal canal, in consequence 
of which it has a laxative action. In this combination of tonic and 
cathartic effects, cascara resembles rhubarb (Tcheltzaffon). Although 
a cholagague action is ascribed to it, there is no reason to suppose that 
it possesses this property in any higher degree than rhubarb. It is well 
adapted for the relief of catarrhal jaundice, and it is useful in cases of 
dyspepsia accompanied by constipation. Habitual constipation, as a 
merely functional state, has been cured by it, and it is now much in re- 
quest for the treatment of that condition. As a laxative, for the relief 
of haemorrhoids and affections of the pelvic organs, it is quite useful. 

Authorities referred to : 

Eymery, Dr. These de Paris, 1884. Quoted by Journal de Therapeutique, 1884. 
Limousin, M. Pharmacist. Bulletin General de Therapeutique for 1884. 
Tcheltzaffon, Dr. Research in Professor Botkin's Laboratory. Quoted by Virchow 
und Hirsch's Jahresbericht for 1886. 

Oleum Ricini. — Castor-oil. Huile de riein, Fr. ; Castorol, Ger. A 
fixed oil expressed from the seed of Ricinus communis Linne (Nat. 
Ord. Euphorbiacece). Dose, 3 j — ? j. 

Properties and Composition. — Castor-oil has a pale amber-color, 
a rather nauseous taste, and is quite viscid. Cold increases the viscid- 
ity. It has a specific gravity of about 0*96. It contains several fatty 
45 



690 EVACUANTS. 

acids—palmitic and ricinoleic — the latter peculiar to castor-oil. The 
seeds appear to contain a drastic constituent, which is more powerfully 
purgative than the oil. The purer the oil, the less active its purgative 
property. 

Acxioxs axd Uses. — Castor-oil is a mild but very certain and effi- 
cient laxative. It operates in from four to six hours, causing but little 
pain, and producing copious stools. It increases but slightly the in- 
testinal secretions — hence the stools are not very liquid. Its purgative 
principle enters the blood, and the milk of the mother may in this 
way acquire a purgative property. It does not appear to have any 
effect upon the hepatic secretion. RGhrig's experiments, which dem- 
onstrated this point, have been confirmed by the subsequent investi- 
gations of Rutherford and Yignal. After the action of castor-oil has 
been completed, it may not unfrequently be seen floating on the stool ; 
yet Buchheim (Husemann) has been unable, after careful examination 
of the faeces, to discover in them castor-oil or any of its derivatives. 

Castor-oil is justly held in great esteem as a laxative for children, 
for pregnant women, for the puerperal state. When hardened fasces 
and irritating substances are to be removed from the intestinal canal, 
castor-oil is the most efficient purgative compatible with safety. When 
inflamed haemorrhoids, fissures of the anus, or surgical operations on 
the pelvic viscera, require the use of a mild, certain, but unirritating 
laxative, castor-oil should be selected. Unfortunately, its taste is so 
repugnant to many palates, that no considerations will overcome the 
disgust which it excites. No remedy is more useful in the diarrhoea 
of children, induced and maintained by undigested aliment or irritat- 
ing secretions. It is judicious practice, in these cases, to give a laxa- 
tive dose of castor-oil to empty the canal, and follow it with an opiate 
or enema of laudanum. The dysentery of children, and sporadic dys- 
entery of adults, especially after the more acute febrile symptoms have 
subsided, are generally very successfully managed by an emulsion of 
castor-oil : I£ 01. ricini, 3 j ; mucil. aeaciae, syrup, simplicis, aa § ss ; 
aquae cinnamomi, § ij. M. Sig. : A tablespoonful every four to six 
hours. In cases of dysentery, when there are much pain, tenesmus, 
and frequent passages, ten to twenty drops of laudanum may be added 
to each dose ; when there are much depression, a low state of the ar- 
terial tension, and a dry, glazed tongue, five drops of turpentine may 
also be added. 

A poultice made of the leaves of the castor-oil plant applied to the 
breasts, it is said, has the power to promote the secretion of milk. 
Warm applications to the mammae undoubtedly stimulate their func- 
tional activity, but it is questionable whether castor-oil leaves have a 
special galactagogue property. It is said, however, that the inhabit- 
ants of the Cape Verd Islands have long been acquainted with this 
supposed property. The internal use of a fluid extract of the leaves 



CATHARTICS. 691 

has also, it is supposed, the power to determine an increased secretion 
of milk. Jaborandi will probably prove to be more effective in this 
respect than the ricinus communis. 

Saline Purgatives. — Many of these have been discussed elsewhere ; 
some of them are no longer employed in medical practice. The sul- 
phate and the citrate of magnesium may be regarded as typical repre- 
sentatives of the class, and hence, in a statement of their physiological 
actions and therapeutical applications, may be comprehended all that 
is of immediate and practical value on the subject. 

Magnesii Sulphas. — Sulphate of magnesium. Sulfate de magnesie, 
Fr. ; Bittersalz, Ger. In colorless crystals, which slowly effloresce on 
exposure to the air, and are very soluble in water. Dose, 3 j — ? j- 

Magnesii Citras Granidatus. — A white, coarsely-granular salt, del- 
iquescent on exposure to air, odorless, having a mildly acidulous, re- 
freshing taste, and an acid reaction. Soluble with copious efferves- 
cence in two parts of water at 60° Fahr. ; almost insoluble in alcohol. 
Dose, 3 j — 3 iv. 

Liquor Magnesii Citratis. — Solution of citrate of magnesia. Dose, 
| iv — ? viij. A tablespoonful of the granular salt added to a half- 
tumblerful of water, and drunk during effervescence, is the quantity 
and the form in which it may also be taken. The bottled solution, 
which is also highly effervescent, must be drunk immediately on being 
poured out. It is a pleasant drink, and, when properly prepared, an 
active cathartic. 

Physiological Actions of Saline Purgatives. — As a general 
rule, saline cathartics are easily borne by the stomach ; especially is 
this true of the Epsom salts. The purgative action is due chiefly to 
increase of the intestinal secretions, and hence the stools are large and 
watery. Thiry and Radziejewski had apparently demonstrated that 
all purgatives acted by increasing the peristaltic movements, but ex- 
actly opposite results have been obtained by Moreau, whose observa- 
tions have been confirmed by Yulpian and Brunton. The conclusion 
reached by the last-named observer is expressed as follows : " Such 
positive results as these seem to prove that purgatives' do cause a flow 
from the intestinal wall, quite as conclusively as experiments with 
Thiry's fistula do the opposite ; and, as the conditions under which the 
purgatives act on the intestines more nearly approach the normal in 
Moreau's than in Thiry's experiments, there can be little doubt that 
purgatives produce a decided secretion of fluid from the intestines, as 
well as accelerate peristaltic movements." Of the agents employed 
by Brunton in his experiments — croton-oil, elaterin, gamboge, jalapin, 
and sulphate of magnesia — the greatest secretion was caused by the 
latter. The results of the best directed experiments are, therefore, in 



692 EVACUANTS. 

accord with clinical observations, and it may hence be considered as 
established that saline cathartics produce an outpouring of fluid into 
the intestinal canal. This outward osmosis occurs chiefly from the 
vessels, and is not truly a secretion of the glandular appendages of the 
mucous membrane. 

Theeapy. — The saline purgatives are indicated in acute inflamma- 
tory affections, as a part of the denutrition treatment. If the arterial 
tension is abnormally high, purgatives, especially the salines, lower it, 
as the sphygmographic tracings show. When a considerable quantity 
of serum is withdrawn from the intestinal vessels, the blood-pressure is 
necessarily diminished elsewhere (Brunton). Free transudation from 
the blood-vessels of the intestinal canal lessens the amount of work 
which the kidneys have to do, and, if these organs are hyperaemic, re- 
moves the congestion. Saline cathartics are therefore very important 
remedies in the treatment of renal and cardiac dropsy. Free purga- 
tion, also, influences the condition of the kidneys by reflex action. As 
a result of the lessened hyperemia of the kidneys, the diminution of 
the blood-pressure, and the reflex stimulation of these organs, the ac- 
tion of a purgative is often followed by greatly-increased activity of 
the renal function. In ascites from obstruction of the portal circula- 
tion, saline cathartics are even more conspicuously beneficial than in 
general dropsy — for in this case they affect directly the organs in : 
volved. Chol&mia, urcemia, oedema of the brain, increased intra- 
cranial blood-pressure from any cause, are conditions requiring the use 
of active saline cathartics. 

The most important applications of saline cathartics are in the treat- 
ment of various intestinal disorders. When the stomach is irritable, 
and the intestines inflamed, no other purgative is so well borne as Ep- 
som salts, and its use may be resorted to when any other agent of the 
kind would be inadmissible. Impaction of the ccecum, and typhlitis 
resulting from this cause, may be removed by the proper administration 
of this remedy. It is unsafe, by active and drastic purgatives, to at- 
tempt to unload the bowel — for these harsh measures will only aggra- 
vate the existing inflammation. Epsom salts will liquefy the fecal 
masses and deplete the vessels, and thus remove the obstruction with- 
out causing any irritation. Small doses frequently repeated are more 
suitable than a large purgative dose. Usually about a teaspoonful in a 
wineglassf ul of water, every three hours, will be the quantity required. 
Perityphlitis and the peritonitis arising from inflammation and perfora- 
tion of the appendix vermiformis are conditions in which purgatives of 
any kind are inadmissible. 

The constipation which accompanies lead-colic can be overcome by 
Epsom salts. 3 Magnesii sulphatis, f j ; acidi sulphuric, dil., 3 j ; 
aquse, 1 iv. M. Sig.: A tablespoonful every three hoiws. As Brunton 
has pointed out, the administration of Epsom salts is a very important 



CATHARTICS. 693 

expedient in the treatment of the saturnine cachexia. Lead, as well 
as other minerals, mercury and copper, for example, is eliminated with 
the bile, and is discharged into the intestine, where it is again ab- 
sorbed. For an indefinite period, therefore, the absorption and dis- 
charge of the same metal may be going on ; and hence the utility of 
giving purgative doses of Epsom salts during the treatment of lead- 
poisoning. 

The most efficient treatment of acute dysentery is by the adminis- 
tration of sulphate of magnesia. It is especially adapted to the acute 
stage when there are fever, pain, tenesmus, and stools of mucus and 
blood. It lessens the hyperemia and causes fecal evacuations, with the 
result of relieving the pain and the distressing straining. It is admin- 
istered as follows : Take a sufficient quantity of sulphate of magnesia 
to saturate eight ounces of water, and to this saturated solution add 
one half ounce of diluted sulphuric acid. The dose of this is a table- 
spoonful every hour or two, in a wineglassful of water, until it oper- 
ates. Sulphate of morphine may be combined with it, or starch ene- 
mata with laudanum may be employed. 

The bleeding from, hmmorrhoids may sometimes be arrested by the 
above-described solution of Epsom salts and sulphuric acid, especially if 
the state of the haemorrhoidal vessels be due to constipation. Uterine 
haemorrhage caused by the presence of a fibroid, or by subinvolution, 
and congestion of the pelvic viscera, are not unfrequently relieved by 
the same agent when other agents apparently more powerful fail. 
When congestion of the pelvic organs, constipation, and anaemia coex- 
ist, the following is an efficient remedy : 3 Magnesii sulphat., § j ; f erri 
sulphat., manganesii sulphat., aa 3j ; acid, sulphur, dil., 3 ij ; aquae, 5 iv. 
M. Sig. : A tablespoonful in a wineglassful of water each morning 
before breakfast. For habitual constipation in those of full habit and 
active circulation, a daily morning dose of a teaspoonf ul of Epsom salts 
is often a permanently effective remedy. 

The disagreeable taste of Epsom salts is perfectly well covered by 
coffee. Boil for two minutes in an earthen vessel one ounce of sul- 
phate of magnesia and two and a half drachms of roasted coffee in a 
pint of water ; then remove from the fire, allow it to " draw " for a 
few minutes, and strain. 

The other saline purgatives belonging to this group are : 

Sodii Sulphas, sulphate of sodium, Glauber's salts, 

Potassii Sulphas, sulphate of potassium ; but both of these have 
long since ceased to be used. 

Sodii Phosphas, phosphate of sgda, 

Potassii et Sodii Tartras, tartrate of potassium and sodium, Ro- 
chelle salts, and 

Pidvis Effervescens Compositus, effervescing aperient powders or 
Seidlitz powders, have been considered elsewhere. 



694 EVACUANTS. 

Potassii JSitartras, bitartrate of potassium, cremor tartar, may also 
be regarded as a member of this group, although it has but feeble pur- 
gative property. 

Mercurial Purgatives. — As the actions and uses of the mercurial 
preparations have been sufficiently discussed elsewhere, little need be 
said in addition as respects their applications as purgatives. 

Hydrargyri Chloridum Mite. — Mild chloride of mercury. Calo- 
mel. Dose as a cathartic, gr. j — grs. x. 

Massa Hydrargyri. — Mercurial pill. Blue mass. Dose, grs. v — 
grs. xv, as a cathartic. 

Actions and Uses. — These mercurial purgatives are rather slow in 
their action. A dose at bedtime will usually operate during the course 
of the following morning. One grain of calomel or five grains of 
mercurial pill will produce distinct purgative effects in most persons 
in about twelve hours, unless there be considerable habitual torpor of 
the bowels. They are apt to cause griping pains, nausea, and even 
vomiting, when the purgative effects begin. First brownish and bad- 
smelling, and afterward greenish stools, supposed formerly to be char- 
acteristic of the mercurial action, are produced. Much heated discus- 
sion has arisen as to the cholagogue action of mercury. Without 
entering into details on this point, it may be admitted that bile- 
elements are found in the stools from the action of mercury, as they 
are unquestionably found in the stools caused by some other purga- 
tives. The presence of bile-elements in the fseces discharged, only 
proves that mercurial cathartics swept them out with the other 
contents of the intestinal canal, and does not prove that an excitant 
action was exerted on the secretory function of the liver. The stored- 
up bile in the gall-bladder may be emptied into the intestine in obe- 
dience to a reflex influence transmitted from the intestinal mucous 
membrane irritated by the purgative. Experimental investigations 
must be invoked to determine the question whether mercurials actu- 
ally stimulate the liver to the production of an increased quantity of 
bile. In another place the experiments of Hughes Bennett's Edin- 
burgh Committee have been stated. Since the report of that commit- 
tee has made its appearance, the very accurate and painstaking inves- 
tigations of Rutherford and Vignal have been published. Rohrig had 
already determined as the result of his experiments that " with large 
doses (twenty grains for a dog) it rarely happened that the secretion 
of bile was recalled after it had come to a standstill, although this 
agent can increase the secretion wljen it is only diminishing." Ruth- 
erford and Yignal arrived at the following conclusions as the results 
of their experiments with calomel : "1. An increase of the biliary se- 
cretion followed the administration of two successive doses of ten 
grains of calomel in one case (Experiments 30). Diminution of the 



CATHARTICS. 695 

secretion was the only result of the same doses given under similar 
circumstances in other two cases (Experiments 31 and 32) ; and it 
was the most definite result of the administration of four successive 
doses of three grains in another case (Experiment 33). 2. In all the 
four experiments the calomel had a purgative effect. 3. Analysis of 
the bile secreted during the calomel purgation in Experiment 33 
showed that, notwithstanding a diminution in the quantity of bile 
secreted, the percentage amount of solids had become less." The 
results of experiment render it probable that mercurials do not in- 
crease the secretion of bile in animals, but we are not without con- 
firmatory evidence in the human subject. In the cases of biliary fis- 
tulse (accidental) observed by Westphalen and Ranke, no increase, but 
rather a diminution in the amount of bile, followed the exhibition of 
calomel in purgative doses. 

That the purgative action of mercurials has a distinctive and pe- 
culiar quality, a vast clinical experience attests. The stools are rather 
different from those caused by other purgatives, and the therapeutical 
effects are, it is generally held, sui generis. Whatever peculiarity per- 
tains to the purgative action of mercurials is probably due to the fact 
that they greatly increase the elimination of the products of waste, or 
retrograde metamorphosis of tissue, by the intestinal glandular appa- 
ratus. 

As a purgative, the use of mercury is restricted to those cases in 
which a deficiency of bile is supposed to be the cause of the morbid 
state — clay-colored stools, jaundice from catarrh of the gall-ducts ; and 
to those cases, singularly enough, in which bile is supposed to be in ex- 
cess — biliousness, so called, jaundice from excessive production of bile, 
etc. For further remarks on the actions and uses of mercury the 
reader is referred to the section on remedies used to promote destruc- 
tive metamorphosis. 

TONIC-ASTRINGENT AND RESIN-BEARING PURGATIVES. 

Senna. — Senna. The leaflets of Cassia acutifolia Delile (Alexan- 
dria senna), and of Cassia elongata Lemaire-Lisancourt (India senna), 
(Nat. Ord. Leguminosai, Ccesalpinaceaz). (U. S. P.) Feuilles de sene, 
Fr. ; Sennesbldtter, Ger. 

Confectio Sennas. — Confection of senna. (Senna, coriander-seed, 
licorice, figs, prunes, tamarinds, cassia.) Dose, 3 j — 3 ij. 

Extractum Sennm Fluidum. — Fluid extract of senna. Dose, § ss. 

Infusum Sennce Compositum. — Infusion of senna. (Senna, § j ; 
coriander-seed, 3 j ; boiling water, Oj.) Dose, § iv. 

Syrupus Sennas. — Sirup of senna. Dose, 3 ss — 3 ij. 

Composition. — The active constituents of senna prove to be a pe- 
culiar colloid body, and an acid, to which has been given the name 



696 EVACUANTS. 

cathartic acid. It has been shown that " cathartate of ammonia pos- 
sesses, in a concentrated form, the purgative activity of the original 
drug." Two bitter principles have been obtained from senna — senna- 
crol and sennapicrin. It contains also a peculiar sugar — catharto- 
mannite. 

Actions and Uses. — The taste of senna is nauseous and bitter. In 
infusion — the form in which it is most usually prescribed — it is most 
disagreeable in odor as well as taste. It produces a sense of warmth 
in the stomach, and causes much flatulence and griping, which may, 
however, be prevented by combination with aromatics. Its active 
principles are absorbed, and the milk of the mother taking senna ac- 
quires a purgative property. It is a very efficient cathartic, producing 
copious liquid stools in about four hours. It does not cause inflamma- 
tion or hypercatharsis, and its purgative action is not followed by in- 
testinal torpor and constipation. It were, therefore, a very safe and 
serviceable cathartic, if it were not so disagreeable. 

The confection of senna is a palatable preparation, and a mild laxa- 
tive, operating without any disturbance. It is used chiefly to correct 
the constipation of pregnancy, but it is highly prized by some patients 
as a remedy for habitual constipation. It is also taken to procure soft 
and easy evacuations in haemorrhoids, fissures of the anus, etc. A 
large bolus (one hundred and twenty grains), taken at bedtime, will 
operate gently on the following morning. The fluid extract of senna 
is a form for the administration of this drug more agreeable than the 
infusion. These two preparations are very excellent cathartics to over- 
come constipation, especially when ordinary purgatives fail. 

The action of senna is much improved by combination with other 
purgatives, and with aromatics. The well-known " black draught " is 
an infusion of senna with sulphate of magnesia — one ounce of the latter 
dissolved in four ounces of the former. By the addition of coffee, the 
odor and flavor of senna may be rendered more tolerable. Two 
drachms of senna and one drachm of coffee may be infused in three 
ounces each of hot milk and boiling water, and the whole drunk after 
twelve hours. 

Rheum. — Rhubarb. The root of Rheum officinale Baillon, and of 
other undetermined species of Rheum (Nat. Ord. Polygonaceoi). Rhu- 
barbe, Fr. ; Rhabarber, Ger. 

Extractum Rhei. — Extract of rhubarb. Dose, grs. x — grs. xv. 

Mtfractum Rhei Fluidum. — Fluid extract of rhubarb. Dose, 3 ss 

-3ij. 

Piluloe Rhei. — Rhubarb-pills. Each pill contains three grains oi 
rhubarb and one grain of soap. 

Pilulm Rhei Composite. — Compound pills of rhubarb. (Rhubarb, 
purified aloes, myrrh.) Dose, 2 — 4 pills. 






CATHARTICS. 697 

Syrupus Rhei. — Sirup of rhubarb. (Fluid extract, § iij ; simple 
sirup, | xxix.) Dose, 3 ss — 3 ij. 

Tinctura Rhei Aromaticus. — Aromatic tincture of rhubarb. (Rhu- 
barb, cloves, cinnamon, nutmeg.) Dose, 3 ss — 3 ij. 

Tinctura Rhei. — Tincture of rhubarb. Dose, 3 j — % ss. 

Tinctura Rhei Dulcis. — Sweet tincture of rhubarb. Dose, f ss — 

Vtnum Rhei. — Wine of rhubarb. (Rhubarb, calamus, stronger 
white wine.) Dose, 3 j — S ss. 

Pulvis Rhei Compositus. — Compound powder of rhubarb. Dose, 
a teaspoonful. 

Composition. — Rhubarb contains a number of substances which 
have been isolated, but its composition has not yet been accurately 
determined. It contains two acids, rheo-tannic and rheumic, a resin- 
ous body, phceoretin, and chrysophan, or chrysophanic acid. 

Physiological Actions. — In small doses, rhubarb is a tonic astrin- 
gent. It promotes the appetite and the digestive power, and, by virtue 
of its tannin, is astringent and diminishes peristalsis. As it contains 
also a purgative principle, in sufficient doses cathartic effects follow its 
administration. The stools are stained by the coloring-matters of the 
rhubarb, are of a yellowish-brown color, and are rather soft without 
being watery. After the purgative action has ended, the astringent 
constituents assert their power and constipation results. As the stools 
present an appearance to which the term " bilious " was applied, it 
was formerly supposed that rhubarb had the power to increase the 
flow of bile ; more recently it has been universally conceded that the 
coloring-matter of rhubarb produces the peculiar tint referred to. The 
latest investigations of Rutherford and Yignal have, apparently, very 
conclusively shown that rhubarb really possesses the property anciently 
ascribed to it, and that it must be placed among the cholagogue medi- 
cines. As it is now known to increase the flow of bile, it may be as- 
sumed that the intestinal secretions in general are promoted by it. 
These effects, which indeed are produced by all the purgatives contain- 
ing a resin, are probably due to phaeoretin — the rhubarb resin. 

The coloring-matters of rhubarb stain the perspiration, milk, and 
urine, and the milk acquires a bitter taste and purgative properties. 

Therapy. — The infusion of rhubarb is frequently employed as a 
vehicle for the administration of alkalies and mineral acids in sto- 
machic disorders. In small doses, the tincture is an excellent sto- 
machic tonic in dyspepsia with deficient biliary and intestinal secre- 
tions. It is adapted to those of a relaxed habit, and is inadmissible 
when a hyperemia of the mucous membrane exists. 

Rhubarb is a remedy of the greatest utility in the duodenal catarrh, 
and in the catarrh of the biliary ducts xoith jaundice, as these maladies 
occur in children. The passing of whitish, pasty, or clay-colored stools, 



69S EVACUANTS. 

while the skin presents an earthy or jaundiced hue, is the indication for 
the use of rhubarb. It is true that the stools will be quickly stained, 
so as to present the bilious character, without any improvement having 
necessarily taken place in the local malady ; but it is also true that 
rhubarb is curative in the conditions above described. In the summer 
diarrhoea of children, no remedy is more generally prescribed. The 
aromatic sirup of rhubarb is a pleasant form in which to administer it. 
In this disorder, especially if the motions are sour, alkalies should be 
prescribed with the rhubarb. Magnesia, chalk, or sodium carbonate, 
may be given with the powder of rhubarb, the fluid extract, or the 
sirup. The following is an excellent formula in these cases : 3 Infus. 
rhei, 3 iij ; potassii bicarb., 3 j ; tinct. cinnamomi, 3 ij ; syrp. simplicis, 
3 vj. M. Sig. : A teaspoonful every hour or two in cholera infan- 
tum. Diarrhoea in children or adults, due to the presence of undi- 
gested food, or retained irritating secretions, may not unfrequently be 
cured by a purgative dose of some rhubarb preparation. After the 
purgative effect is expended, the bowels are confined by the astringent. 
In acute dysentery the saline purgatives are much more appropriate 
than rhubarb. 

In habitual constipation good effects may be obtained by chewing 
some rhubarb-root. The astringent after-effect is, however, a decided 
objection to the frequent use of this remedy for this purpose. In the 
rhubarb-pill the astringency is counteracted by soap. The compound 
rhubarb-pill, which contains aloes, is a mild and efficient cathartic. 

Aloe. — Aloes. The inspissated juice of the leaves of Aloe Socotrina 
Lamarck (Nat. Ord. Liliaceai). 

Aloe Purificata. — Purified aloes. In brittle pieces of a dull-brown 
or reddish-brown color, and having the peculiar aromatic odor of Soco- 
trine aloes. It is almost entirely soluble in alcohol. (U. S. P.) Dose, 
gr. j— grs. v. 

Extractum Aloes Aquosum. — Watery extract of aloes. Dose, gr. 
ss — gr. v. 

Pilulw Aloes. — Pills of aloes. Each pill contains two grains of 
aloes and two grains of soap. Dose, 1 — 5 pills. 

Pilulce Aloes et Asafoeticlce. — Pills of aloes and asafoetidae. (Aloes, 
asafoetidse, and soap, in equal parts.) Dose, 2 — 5 pills. 

Pilulai Aloes et Mastiches. — Pills of aloes and mastic. Lady Web- 
ster's pills. (Aloes, mastic, and red rose.) Dose, 1 — 2 pills. 

Pilulw Aloes et Myrrhm. — Pills of aloes and myrrh. (Aromatic 
powder, myrrh, aloes.) Dose, grs. v — grs. xv. 

Tinctura Aloes.— Tincture of aloes. Dose, 3 ss — J j. 

Tinctura Aloes et Myrrhm. — Tincture of aloes and myrrh. Dose, 
3 ss— 3 ij. 

Yinum Aloes. — Wine of aloes. Dose, 3 j — % ss. 



CATHARTICS. 699 

Pulvis Aloes et Canellce. — Powder of aloes and canella (hiera 
picra). Dose, grs. v — 3]. (Not official.) 

Composition. — The odor of aloes is due to a peculiar volatile oil. 
It contains also a resin, and a principle, alolne. The composition of 
aloi'ne is not precisely the same in the different varieties of aloes. The 
Barbadoes aloes furnishes barbaloine, the Natal aloes, natalo'lne, and 
the Socotrine aloes, soalo'lne. These varieties, it is supposed, consti- 
tute an homologous series. 

Actions and Uses. — Aloes has a bitter and very disagreeable taste, 
leaving a rather acrid after-sensation in the fauces. It is a stomachic 
tonic, and, like bitters in general, it promotes the appetite and diges- 
tion. Accordingly, it is much prescribed as a stomachic tonic in cases 
of indigestion loith torpor of the large intestine. Irritable or inflam- 
matory states of the stomach mucous membrane contraindicate its 
employment. 

The recent investigations of Rutherford and Yignal have shown 
that aloes has the power to stimulate the hepatic functions, and to 
promote the flow of bile. This result is confirmatory of clinical expe- 
rience. In large doses (twenty grains or more) aloes undoubtedly in- 
creases the intestinal secretions generally ; but, in the ordinary medici- 
nal laxative dose, the stools are not liquid, and are but little altered 
in character. The principal effect of aloes is expended on the large 
intestine, the peristaltic movement of which it increases. Some tor- 
mina is experienced when the laxative effect begins, and tenesmus, 
with heat and irritation of the rectum, is produced when an active 
purgative dose has been taken. The blood -supply to the pelvic 
organs is increased by aloes ; the menstrual flow becomes more 
abundant, and abortion, it is said, may be caused by its incautious 
administration ; while in the male, erections take place more fre- 
quently. 

Ten or twelve hours elapse after it has been swallowed, before 
cathartic effects are produced. The rate at which it moves to affect 
the intestinal canal is influenced less by the size of the dose than by 
the condition of the bowels. 

The purgative principle of aloes diffuses into the blood. Applied 
to an exposed surface, it is absorbed and purges, and the milk of moth- 
ers taking it acquires a purgative action. 

Simple jaundice, of an atonic kind, may be cured by aloes. No 
purgative is more efficient in constipation, dependent on weakness and 
impaired contractility of the muscular layer of the large intestine. 
Jaundice, or at least a bilious state, a coated tongue, foul breath, a 
tumid abdomen, and an impacted colon, are conditions frequently 
associated and are readily relieved by aloes. The constipation of 
hypochondriasis and melancholia is best overcome by the use of this 
agent, and, with the removal of the impacted fasces, there is not un- 



700 EVACUANTS. 

frequently an improvement in the mental state. Aloes is prescribed 
in cerebral disorders, when purgatives are given with a view to a 
derivative effect. 

In amenorrhcea which is dependent on anaemia, aloes is prescribed, 
with other appropriate remedies, to determine an afflux of blood to the 
uterine system. Menorrhagia, occurring in debilitated and relaxed 
subjects, is sometimes relieved in the same way. Iron may be asso- 
ciated with aloes in these cases. Congestion of the pelvic viscera is a 
contraindication to the use of aloes, and the existence of haemorrhoids, 
or of a tendency therefor, has heretofore been considered an equally 
positive contraindication. Fordyce Barker has, however, shown that 
aloes has a curative power in certain cases of haemorrhoids, and nota- 
bly those which occur after delivery. The local condition, under these 
circumstances, is not one of active hyperaemia, but really consists in a 
sluggish state of the circulation in the inferior haemorrhoidal veins. 
It can hardly be doubted that aloes would increase the trouble if pre- 
scribed for cases in which there was active congestion of the pelvic 
viscera. Barker also advocates the use of aloes in non-puerperal 
haemorrhoids, but the local condition must be suitable for the use of 
this remedy or the disease will be aggravated. The following are for- 
mulae proposed by Barker: $ Pulv. aloes Soc, sapo. Cast., aa 3] ; 
ext. hyoscyami, 3 ss ; pulv. ipecacuanhae, grs. v. M. Ft. pil. no. xx. 
Sig. : One pill morning and evening. "When the haemorrhoids are 
associated with an irritable rectum, and with frequent, small, teasing, 
thin evacuations, Barker substitutes for the hyoscyamus a small quan- 
tity of opium, giving also a less quantity of the aloes, as in the fol- 
lowing formula : $ Ferri sulph., 3 j ; pulv. aloes Soc, ext. opii aq., 
sapo. Cast., aa grs. x. M. Ft. pil. no. xx. Sig. : One pill morning 
and evening. Oppolzer also used aloes as a remedy for haemorrhoids, 
prescribing, when there was constipation, aloes and quinine, and, when 
the bowels were not confined, aloes and sulphate of iron. 

The action of aloes, as well as of other resin-bearing purgatives, in 
the condition of anaemia, is promoted by the conjoined use of the bit- 
ters, quinine, iron, and tonics generally. Two grains of aloes, taken at 
bedtime, will cause a satisfactory evacuation on the following day. 
Combination with soap, as in the official pil. aloes, and pil. aloes et 
asafoetidae, diminishes the drastic, while it increases the efficiency of 
the purgative, action. It is generally better to give aloes by itself, 
without combination with other cathartics ; but its purgative effects 
may be greatly enhanced by administering a saline laxative six or eight 
hours after the aloes has been taken. 

A gonorrhoea may, it is said, be cured by the internal use, three 
times a day, of a pill containing two or three grains of aloes. Catarrh 
of the uterus has been treated successfully by aloes rectal enemata. 
The tincture of aloes, diluted to one half or even more, by water, is a 



CATHARTICS. 701 

very effective injection in gonorrhoea after the acute symptoms have 
subsided. 

Jalapa. — Jalap. The tuber of Exogonium purga Bentham (Nat. 
Ord. Co?ivolvulacece). Racine de jalap, Fr. ; Jalape, Ger. 

Abstractum Jalapw. — Abstract of jalap. Dose, gr. j — gr. v. 

Mesina Jalapw. — Resin of jalap. Dose, grs. ij — grs. v. 

Pulvis Jalapce Compositus. — Compound powder of jalap. (Jalap, 
one part ; bitart. of potassa, two parts.) Dose, gr. x — 3 j. 

Composition. — Jalap contains a resin, to which its purgative prop- 
erty is due. The resin consists of two varieties, one soluble, the other 
insoluble, in ether. The latter has been named convolvidin, or jalap- 
in, and is the more active purgative of the two. Various secondary 
products of considerable interest are obtained from the resin, but these 
possess no special importance from the therapeutical point of view. 

Physiological Actions. — As a cathartic jalap resembles, but it is 
much more active than, senna. It is apt to produce nausea, and tor- 
mina and tenesmus invariably accompany its purgative action. It 
usually operates in from two to four hours, but the rate at which it 
moves to affect the intestinal canal is not influenced by the amount 
administered. The stools are soft at first, and afterward liquid. Jalap 
does not produce haemorrhoids, nor does it cause a tendency to, or 
increase an existing, menorrhagia. The secretions of the intestinal 
canal are increased by it, and the recent researches of Rutherford and 
Yignal have demonstrated that jalapin (convolvulin) excites the flow 
of bile. 

The action of jalap appears to be local. It is true that experiments 
in support of a contrary opinion have been made ; but, in the conclu- 
sive test of the intra-venous injection of convolvulin, no purgative 
action has followed (Husemann). 

Theeapy. — The resin of jalap being the active constituent, it should 
generally be preferred. It has the merit of being almost tasteless, and 
hence may be given readily to children. 

Jalap is an efficient cathartic in the beginning of fevers, inflamma- 
tions, and acute diseases requiring the use of such therapeutic means. 
Formerly calomel and jalap were much prescribed, but this combina- 
tion has deservedly fallen into discredit. Occasionally the resin and 
calomel, in less ponderous doses than formerly given, may be used with 
advantage as a cathartic : $ Resinge jalapse, hydrarg. chlor. mit., ext. 
hyoscyami, aa gr. j. M. Ft. pil. no. j. Sig. : Take at bedtime. 

As jalap in sufficient quantity causes free watery evacuations, it is 
a suitable purgative in anasarca and ascites. The most generally ap- 
proved hydragogue purgative, under these circumstances, is the com- 
pound jalap-powder. The efficiency of this may be increased by the 
addition of podophyllum. A teaspoonful of the compound powder, 



702 EVACUANTS. 

taken in the early morning, will usually produce several very copious, 
watery stools. Increased urinary discharge also is a not unfrequent 
result of its action. 

Jalap has the power to cause the expulsion of limibrici. As a ver- 
mifuge it is not at all equal to the other approved remedies, but it is 
certainly useful as an adjunct. For example, santonin at night, and 
the resin of jalap and calomel on the following morning, is an effective 
method of expelling these parasites. 

Jalap is, of course, contraindicated in inflammatory states of the 
intestinal canal. In overdoses it causes hypercatharsis, and it may 
excite violent gastro-enteritis and endanger life. With proper atten- 
tion to the conditions in which it is admissible, and to the dosage, jalap 
is entirely safe, and is a very certain and efficient cathartic. An ex- 
cellent vehicle for the administration of the resin of jalap is the sirup 
of rhubarb, tjt Resinae jalapse, grs. ij — grs. v ; syr. rhei aromat., § ss. 
M. This is especially suitable for children. 

Scammonium. — Scammony. A resinous exudation from the root of 
Convolvulus scammonia Linne (Nat. Ord. Convolvulacece). (U. S. P.) 
Scammonee, Fr. ; JScammonium, Ger. 

JResina Scammonii. — Resin of scammony. Dose, grs. v — grs. x. 

Composition. — The activity of scammony, as a cathartic, depends 
entirely on the resin which it contains. As the crude scammony is 
much adulterated, the resin is alone worthy of confidence. 

Actions and Uses. — Scammony corresponds very closely to jalap 
in the time it requires to cause cathartic action, in the character of the 
stools produced, and in the kind of irritation which it excites. Scam- 
mony is somewhat more drastic than jalap. As it has but little taste, 
and is at the same time very active, the resin is much prescribed by 
English practitioners as a cathartic for children. It may be given 
rubbed up with milk, or with sirup of rhubarb. It is adapted to the 
same class of cases, and to the relief of the same conditions, as jalap. 

Colocynthis. — Colocynth. The fruit, deprived of its rind, of Citrul- 
lus colocynthis Schrader (Nat. Ord. Cucurbit acece). (U. S. P.) Co- 
loquinte, Fr. ; Koloquinten, Ger. 

Extractum Colocynthidis. — Extract of colocynth. 

JExtractum Colocynthidis Compositum. — Compound extract of colo- 
cynth. (Extracts of colocynth, scammony, and aloes ; cardamoms, 
soap.) Dose, grs. v — grs. x. 

Pihdce Catharticce Composite*}. — Compound cathartic pills. (Com- 
pound extract of colocynth, abstract of jalap, calomel, gamboge.) 
Dose, 1 — 3 pills. Each pill contains one grain of calomel. 

Composition. — Colocynth contains a bitter principle {colocynth in), 
which is the purgative principle. Colocynthitin is another substance 



CATHARTICS. 703 

contained in the alcoholic extract. It differs from colocynthin in being 
soluble in ether, and not in water. As colocynthitin is a tasteless crys- 
talline powder, it is probably devoid of purgative property. Colocyn- 
thin is a very powerful cathartic. 

Actions and Uses. — Colocynth is a gastro-intestinal irritant. In 
moderate doses it hastens the peristaltic movements, and increases the 
intestinal secretions. Its cathartic operation is usually attended with 
griping, and the stools are fluid. Violent gastro-enteritis may be pro- 
duced by a large quantity, and numerous fatal cases have been reported 
from its incautious or criminal administration. 

The action of colocynth is not merely local. Applied to the skin 
of the abdomen, it causes intestinal pain, and more frequent alvine dis- 
charges. 

Colocynth is never administered alone, but usually in combination 
with other purgatives. The compound extract is a safe, effective, and 
not unpleasant cathartic for the relief of constipation. ^ Ext. colo- 
cynthiclis comp., 3j ; ext. belladonna, ext. physostigmatis, aa grs. v. 
M. Ft. pil. no. x. Sig. : One each night in habitual constipation. 
The official compound cathartic pill is a most serviceable combination. 
Instead of calomel the resin of podophyllum maybe used in the prepa- 
ration of this pill, without impairing its utility. 

In cerebral congestion the preparations of colocynth are used as 
derivative purgatives. Hypochondriasis and melancholia, when asso- 
ciated with torpor of the large intestines and fecal accumulations, are 
benefited by brisk purging with the colocynth preparations, but other 
drastic purgatives are equally efficient. 

Colocynth is inadmissible in inflammatory states of the intestinal 
canal, and is unsafe during the existence of pregnancy. There is a 
popular notion, which has led to its use in toxic doses, that colocynth 
may cause abortion. Any quantity which will affect the gravid womb 
must be sufficient to endanger life. 

Podophyllum. — May-apple. The rhizoma and rootlets of Podo- 
phyllum p eltatum Linne (Nat. Ord. Perberidacece). 

Resina Podophylli. — Resin of podophyllum. Dose, gr. \ — gr. j. 

Extraction Podophylli. — Extract of podophyllum. Dose, grs. v 
— grs. x. 

Abstraction Podophylli. — Abstract of podophyllum. Dose, gr. £ 

— gr- J- 

Extractum Podophylli Fluidum. — Fluid extract of podophyllum. 
Dose, ttj, j — 3 ss. 

Composition. — The medicinal qualities of podophyllum are due to 
a resin, or to two resinous substances, one soluble in alcohol and ether, 
and the other soluble in alcohol only. Both possess purgative proper- 
ties. May-apple-root contains the alkaloid berberine, which, however, 



704 EYACUANTS. 

is not peculiar to podophyllum, being found in berberis, hydrastis, and 
other plants. 

Resina podophylli is the preparation entitled "podophyllin " by the 
eclectic practitioners. 

Actions and Uses. — The taste of podophyllum is bitter, with an 
after-sense of acridity. It increases the intestinal secretions, and is 
actively cathartic, producing copious and rather watery stools. Its 
action is similar to, but considerably slower than, that of jalap. From 
six to ten hours elapse after its administration before cathartic effects 
are experienced. Taken by itself, it is apt to cause nausea and griping, 
but in combination with other cathartics, or with belladonna or hyos- 
cyamus, it operates pleasantly as well as efficiently. The Edinburgh 
committee, Dr. Bennett, chairman, ascertained, as they supposed, that 
the resin of podophyllum has no cholagogue action, but the more re- 
cent as well as the more accurately conducted experiments of Ruther- 
ford and Yignal have apparently demonstrated that it decidedly in- 
creases the flow of bile, corresponding in this particular to the other 
resinous cathartics. 

Podophyllum-resin is the most generally useful cathartic in cases 
of constipation, in which the secretions of the glandular apparatus of 
the intestinal canal, and of the liver, are deficient. Habitual constipa- 
tion, due to torpor of the muscular layer of the bowel, may, it is said, 
be removed by the nightly use of a small dose of the resin combined 
with belladonna, fy Resinse podophylli, grs. vj ; ext. belladonna?, ext. 
physostigmatis, aa grs. iij. M. Ft. pil. no. xij. Sig. : One pill each 
night. It is especially in congestion of the portal circulation, in catar- 
rhal and malarial jaundice, and in ascites, that podophyllum-resin acts 
most efficiently and serviceably. Haemorrhoids that bleed in conse- 
quence of stasis in the portal circulation, and that are of recent forma- 
tion, may sometimes be cured by a brisk podophyllum cathartic. 

The clinical experience which had shown that the resin of podo- 
phyllum possessed cholagogue powers, long before the experimental 
inquiry was instituted to settle the question, led also to a wide gener- 
alization in the therapeutical uses of this agent. Acting on the liver, 
it was assumed that, in a manner similar to mercury, it must also pos- 
sess similar " alterative " powers. It came to be used as the " vege- 
table calomel," in the diseases in the treatment of which mercury was 
supposed to be essential. It need hardly be asserted that these specu- 
lations have no basis, and that podophyllum possesses no property in 
common with mercury except its power to purge. 

Leptandra. — Leptandra. The rhizoma and rootlets of Zeptandra 
Yirginica Nuttall (Xat. Ord. Scrophulariacece). 

Extr actum Leptandrce.— Extract of leptandra. Dose, gr. ij — 
gr. x. 



CATHARTICS. 705 

Extractum Leptandrce Fluidum. — Fluid extract of leptandra. 
Dose, hi v — 3 j. 

Composition. — A crystallizable principle has been obtained from 
the root — leptandrin (?). It contains also a resin which, in the impure 
form at present found in commerce, has a distinctly purgative quality 
and is known as leptandrin. The dose of this preparation is gr. ij — 
gr. v. 

Actions and Uses. — Leptandra is an active cathartic in the recent 
state. In the form of the fluid extract, or of the so-called leptandrin, 
it acts mildly, causing somewhat liquid and apparently bilious stools. 
It is held to be cholagogue, and, according to the rules of analogy, this 
claim may be well founded, for other cathartics containing resin, as 
the experiments of Rutherford and Yignal have shown, possess the 
power to increase the flow of bile. 

It is applicable to cases of disease of the intestinal canal, attended 
by constipation, in which the biliary and intestinal secretions are in- 
sufficient. 

Iris. — Blue flag. The rhizoma and rootlets of Iris versicolor Linne 
(Nat. Ord. Iridacece). 

Extractum Iridis. — Extract of iris. Dose, gr. j — gr. v. 

Extractum Iridis Fluidum. — Fluid extract of iris. Dose, nj, v 
-3j. 

Under the name iridin, there is to be found in the shops a "resi- 
noid," having more or less of the properties of the crude drug. The 
dose of this preparation is from one to five grains. 

Actions and Uses. — Iris versicolor has a bitter, nauseous, and 
rather acrid taste. It is apt to cause severe nausea. The fresh root 
has actively purgative and diuretic qualities, but these are impaired 
by age. The fluid extract and the " iridin " are laxative, and are sup- 
posed to have cholagogue powers. 

The oleo-resin is prescribed in hepatic and intestinal disorders, and 
in dropsy. There is much evidence tending to show that this remedy 
is really serviceable when the stools are clay-colored, and the skin 
jaundiced, in consequence of duodenal catarrh and obstruction of the 
biliary ducts. It is said that malarial jaundice may be cured by this 
drug, and that in bilious remittent fever and in chronic malarial poi- 
soning it exerts a favorable influence. 

Euonymus. — Wahoo. The bark of Euonymus atropurpureus Jac- 
quin (Nat. Ord. Celastracew). 

Extractum Euonymi. — Extract of euonymus. Dose, gr. j — gr. v. 

The eclectic preparation (euonymin) consists of the resin and fixed 
oil, and is prescribed in the dose of a half -grain to five grains. 

Composition. — An uncrystallizable and intensely bitter principle 
46 



706 EVACUANTS. 

has been isolated (euonymin). It contains also a crystallizable, a yel- 
low and a brown resin, fixed oil, etc. 

Actions and Uses. — Euonymus possesses cathartic properties simi- 
lar to rhubarb, but is much milder, and is an excellent remedy in 
hepatic and intestinal disorders requiring the use of such an agent. 
The eclectic preparation (euonymin) is a convenient form in which 
to procure the cathartic action of euonymus. Rutherford has shown 
that it is a highly efficient cholagogue. 

Baptisia. — Wild indigo. The root-bark of JBaptisia tinctoria. (Not 
official.) Preparations corresponding to those of iris and euonymus 
can be obtained. 

JExtr actum BaptisicB. — Extract of baptisia. Dose, gr. j — gr. x. 

Baptisin, the resinoid, is much prescribed by eclectic practition- 
ers. The dose is one to five grains. 

Actions and Uses. — The taste of baptisia is bitter and somewhat 
acrid. It increases the secretions of the glandular appendages of the 
gastro-intestinal mucous membrane. It possesses in large doses emeto- 
cathartic property, and may indeed excite violent gastro-intestinal in- 
flammation ; in small doses it is merely laxative. The resinoid baptisin, 
so called, has been studied by Rutherford, who found it to possess ac- 
tive cholagogue property. Given to dogs, it distinctly stimulates the 
he})atic functions and increases the production of bile. It is probable 
that it deserves to rank among the most efficient of the remedies of 
this group. It is indicated, therefore, in all the cases in which hepatic 
stimulants are desirable. 

HYDRAGOGUE CATHARTICS. 

Cambugia. — Gamboge. A gum-resin obtained from the Garcinia 
Hanburii Hooker filius (Nat. Ord. Guttiferce). (U. S. P.) Gom?ne- 
gutte, Ft. ; Gummigutt, Ger. Dose, gr. j— grs. v. 

The only official preparation is the compound cathartic pill, of 
which gamboge constitutes about a tenth part. 

Composition. — Gamboge is a mixture of resin and gum, the latter 
constituting from fifteen to twenty per cent. 

Actions and Uses. — Gamboge has no taste at first, but, when 
chewed, an acrid sensation is developed in the mouth. It is irritant to 
the gastro-intestinal canal, increases secretion of the glands, excites 
vomiting and intestinal pain, and purges violently, producing copious 
watery stools. The experiments of Rutherford and Vignal show that 
gamboge is not an hepatic stimulant, but does cause hydrocatharsis. 
Violent gastro-enteritis is set up by large doses, yet but few fatal cases 
have been reported. As vomiting soon follows the ingestion of a large 
dose, this fact may explain the rarity of a fatal result due to its ad- 
ministration. 



CATHARTICS. 707 

Gamboge is rarely prescribed alone as a cathartic, owing to the vio- 
lence and harshness of its operation. Combination with other cathar- 
tics, as in the compound cathartic pill, greatly modifies its action. As 
it is a powerful hydragogue cathartic, it is given with advantage in 
dropsy, when hydrocatharsis is indicated. It is best administered in 
small doses, at short intervals, rubbed up with sugar or made into a 
pill with soap. Besides its purgative properties, gamboge is decidedly 
diuretic. In order to obtain its diuretic effects it must be given in 
small doses, at short intervals, and vomiting must be avoided. Admin- 
istered in solution with an alkaline diuretic, its efficiency is much in- 
creased. Gamboge has also been used as an anthelmintic, but it has no 
powers in this respect not possessed by other drastic purgatives. 

Oleum Tiglii. — Croton-oil. A fixed oil expressed from the seeds 
of Croton tiglium Linne (Nat. Ord. Euphorbiacece). (IT. S. P.) 
Huile de Croton, Fr. ; Crotonol, Ger. Dose, gt. j— gtt. ij. 

Composition. — It contains glycerides of the fatty acid series — 
stearic, palmitic, myristic, and lauric acids — and the more volatile acids, 
acetic, butyric, and valerianic (Fliickiger and Hanbury, Husemann). 
Genther and Frohlic have discovered a peculiar volatile acid, to which 
they have applied the name tiglinic acid. By the same chemists the 
so-called crotonic acid is held to be an artificial product. Schlippe 
has asserted the discovery of the vesicating principle of croton-oil, but 
other chemists have failed to find this substance, to which he has as- 
signed the name of crotonol. The purgative principle of the oil ap- 
pears to exist in all parts of the Croton tiglium, but it has not yet been 
isolated. 

Actions and Uses. — Croton-oil is a transparent or semitransparent 
viscid liquid, amber-colored, and having a rather rancid smell, and an 
oily, acrid taste. Applied by friction to the skin, it excites inflamma- 
tion, and causes an eruption which is at first papular, with rounded 
summits, and afterward becoming pustular. The eruption is sometimes 
umbilicated, but is generally rounded. An areola surrounds the pus- 
tules, and there are considerable heat and burning in the part. The 
eruption appears in a few hours after the frictions have been practiced, 
reaches its maximum in about four days, and then declines by abortion 
of the pustules and by scabbing. In many subjects permanent, small 
white cicatrices mark the site of the eruption. All subjects are not 
equally susceptible to the vesicating action of croton-oil. 

The mucous membrane is violently attacked by croton-oil. In the 
fauces it causes an intensely acrid sensation, and increases the flow of 
saliva. A sense of heat, pain, and nausea is produced when the oil 
is received into the stomach, tormina soon follows, and in an hour or 
two watery stools are passed with some burning and irritation about 
the anus. The action of the oil continues during the succeeding twelve 



70S EVACUANTS. 

to twenty-four hours, numerous fluid dejections are passed, and con- 
siderable debility is the result. When large doses are taken, if not 
rejected promptly by vomiting, violent hypercatharsis occurs with 
great prostration and collapse. Fortunately, when an overdose is 
swallowed, vomiting quickly ensues, and hence very large quantities 
have been taken without producing a fatal result. The lesions caused 
by croton-oil are those of gastro-enteritis, but fatal cases have occurred, 
with all the objective phenomena of choleraic collapse, without auy 
evidences of local inflammation. 

As croton-oil is still purgative after being deprived of its acrid 
principle by washing with alcohol, it has been held that the oil be- 
comes cathartic only by the action of the alkaline juices of the duo- 
denum. Numerous instances have been reported, and some have fallen 
under the author's observation, in which croton-oil applied to the 
integument has produced diarrhoea. It must, therefore, act by absorp- 
tion into the blood. In some cases, without causing purging, croton- 
oil affects the nervous system in a peculiar manner. Thus restless- 
ness, palpitation of the heart, headache, giddiness, confusion of ideas, 
etc., have occurred under these circumstances (Husemann). 

Rohrig found that croton-oil stimulated the hepatic function, and 
increased the flow of bile. Radziejewski found peptones, bile, gly- 
cogen, leucin, and tyrosin, in the stools. Rutherford and Yignal have 
since shown that croton-oil, although it causes great vascular dilatation 
of the vessels of the intestinal mucous membrane, can not be regarded 
as a cholagogue. 

The principal effect of croton-oil, for which it is administered in 
medical practice, is that of a hydragogue cathartic. It is, therefore, 
used in dropsies when it is desired to procure free, watery evacuations. 
It is inadmissible when there is much debility, or when an irritable or 
inflammatory state of the intestinal mucous membrane exists. 

Notwithstanding its great activity, croton-oil is an easily-managed 
cathartic for ordinary purposes. It is the most efficient purgative when 
there is simple impaction, without inflammatory symptoms. The con* 
stipation from /ea<#maybe overcome by it, when less powerful purga- 
tives will fail. It is the most appropriate of cathartics, when these 
agents are indicated as revidsives in cerebral congestion. Croton-oil, by 
increasing the vascular dilatation in the intestines, lowers the intra- 
cranial blood-pressure. Per contra, it is harmful when a state of cere- 
bral anaemia exists. 

Croton-oil has been used successfully against tainia, but it has no 
special vermifuge property. 

The smallness of the dose required renders croton-oil a very useful 
purgative in the maladies of children and of the insane. When the 
patient is unable to swallow from insensibility or paralysis, a drop or 
two placed on the tongue will act efficiently. It may be given to chil- 






CATHARTICS. 709 

dren, rubbed up with sugar of milk. As washing with alcohol removes 
the acridity, and does not impair the purgative property, a preparation 
so treated will be best for administration to children. The unpleasant 
effects of this remedy may be much modified by combination with 
other cathartics. r> 01. tiglii, gtt. iij ; ext. colocynth. com., 3j ; ext. 
belladonnae, grs. iij. M. Ft. pil. no. vj. One of these will usually 
act efficiently. The following is the formula of Dr. Francis's " triplex 
pills " : I£ Aloes socot., scammonii, pil. hydrargyri, aa § j ; ol. tiglii, 
hi xx ; ol. carui, in, xc ; elix. proprietatis, q. s. M. Ft. pil. no. 400. 
Dose, as a laxative, one at bedtime. This combination is very popular 
in New York. 

Elaterium. — Elaterium. A substance deposited by the juice of the 
fruit of Momordica elaterium, Ecbalium agreste. (Not official.) Con- 
combre purgatif, Fr. ; Springgurlce, Ger. Dose, gr. -^ — gr. \. 

Composition. — The important constituent of elaterium is elaterin. 
Owing to the uncertainty in the strength of elaterium, it has been 
omitted from the official list, and its active constituent substituted. 

Elaterinum. — Elaterin. A neutral principle extracted from elate- 
rium, a substance deposited by the juice of the fruit of Ecbalium ela- 
terium A. Richard (Nat. Ord. Cucurbit aceoe). 

Small, colorless, shining hexagonal scales or prisms, permanent in 
the air, odorless, having a bitter, somewhat acrid taste, and a neutral 
reaction. Insoluble in water ; soluble in 125 parts of alcohol at 60° 
Fahr. Dose, gr. ^ — gr. \. 

Trituratio Elaterini. — Trituration of elaterin. (Elaterin, 10 parts ; 
sugar of milk, 90 parts.) Dose, gr. ss — gr. ij. 

Actions and Uses. — Elaterium excites an abundant flow of saliva, 
and a persistent bitter taste is experienced in the fauces some time 
after it is swallowed. Nausea and vomiting, profuse, watery stools, 
and great weakness and prostration, are produced by a considerable 
dose of elaterium. The vomited matters and stools have an appearance 
and composition similar to the "rice-water " discharges of cholera. On 
animals elaterium acts somewhat differently. Without causing purg- 
ing, it affects the nervous system, producing irregular respiration, 
hebetude, convulsions, and death (Kohler). The gastro - intestinal 
action is doubtless local, and the result of the immediate impression 
made by the agent in its passage down the intestinal canal. Ac- 
cording to Kohler, the presence of bile is necessary to the action of 
elaterium. 

The chief use of elaterium is to procure free watery evacuations in 
ascites, general dropsy, uroemia, and to act as a revulsive in cerebral 
disorders. It must be used with caution in debilitated subjects. Gas- 
trointestinal irritation, or inflammation, contraindicates its use. The 



710 EVACUANTS. 

depression which its operation induces must be counteracted by stimu- 
lants and proper aliment. 

Authorities referred to : 

Anstie, Dr. F. E. Report on the Physiological Action of Podophyllin. The Medical 
Times and Gazette, vol. i, 1S63. 

Barker, Dr. Fordyce. The Puerperal Diseases, p. 34. 

Brunton, Dr. T. Lauder. On the Action of Purgative Medicines. The Practitioner, 
May, 1874. 

Fluckiger and Hanbury. Pharmacographia. Various articles. 

Husemann, Drs. Aug. und Theo. Die Pfanzenstoffe. 

Husemann, Dr. Theo. Handbuch der gesammten Arzneimittellehre, zweiter Band. 

Kohler, Dr. H. Der Fruchtsaft von Momordica Elaterium in historischer, chemi- 
scher und physiologischer Hinsicht. Virchoufs Archiv, Band xlix, p. 434, 1, p. 2*73. 

Moreau, Armand, Dr. Archives Generates de Med., vol. xvi, p. 234, sixth series. 

Fercy, Dr. S. R. Tlie American Medical Times, vol. iv. 

Radziejewski, Dr. S. Schmidfs Jahrbucher, vol. exlvii, p. 20. Zur physiohg. Wirk- 
ung der Abfuhrmittel. 

Rutherford and Yignal. Experiments on the Biliary Secretion of the Dog. TJie 
British Medical Journal, November, 1875. 

Thiry, Dr. L. Schmidfs Jahrbucher, vol. cxxviii, p. 17. 

Vulpian, Prof. A. Bulletin General de TJierap., vol. lxxxiv, p. 522. 

Enemata. — An enema is a rectal injection. The capacity of the 
rectum, it need hardly be stated, varies with the age of the individual. 
For an infant, half an ounce to an ounce ; for a child of two to five 
years, two to six ounces ; for five to fifteen years, six ounces to a pint; 
for an adult, a pint to a quart of fluid may be considered as an ap- 
proximation to the capacity of the rectum at these ages respectively. 
Habitual use of injections no doubt increases the tolerance, as also the 
capacity of the rectum. 

Injections may consist of water — cold, tepid, warm, or hot ; of 
medicated solutions — emollient, anodyne, laxative, cathartic, or anthel- 
mintic. Under this head are to be considered only enemata adminis- 
tered with the view to cause an evacuation from the intestinal canal. 

Enemata act either by a reflex irritation or by absorption. When a 
cold injection is thrown into the rectum, or this organ is distended, an 
action is set up for the expulsion of the offending substance, and the 
muscular fiber of the bowel more or less vigorously contracts according 
to its functional condition. The quantity, as well as the temperature 
of the fluid injected, must therefore be taken into consideration, when 
it is proposed to empty the bowels by a merely reflex irritation. On 
the other hand, when it is the intention to procure the absorption of 
the medicated fluid, the quantity injected must be relatively small, and 
its temperature should, as nearly as possible, be that of the rectum. In 
order to secure absorption, it is necessary also to regard the laws of 
diffusion. As the secretions of the rectum are alkaline, it is obvious 
that acidulated solutions will diffuse into the rectal veins with the 



CATHARTICS. 711 

greatest facility. It is doubtful whether colloidal substances of them- 
selves are taken up in the rectum. (See Nutrient Enemata, p. 55.) 

Irrigation of the intestines, or forced injections of a large quantity 
of water, is a modern expedient of great practical utility. The appa- 
ratus required for the performance of this operation consists of a rectal 
tube, a flexible rubber pipe three or four feet in length, and a funnel- 
shaped vessel to contain the fluid to be injected. The decubitus on 
either side, the hips being elevated, may be sufficient ; but, to insure 
gravitation of the fluid to the ileo-ca?cal valve, the female patient 
should be placed in Sims's position, and the male patient on his hands 
and knees. The rectal tube should be inserted, and passed up to the 
sigmoid flexure ; the flexible tube should then be attached. The 
height to which the reservoir is raised will regulate the hydrostatic 
pressure, and the flow of fluid through the flexible tube can be lessened 
or increased at the pleasure of the operator by compression with the 
fingers. 

In administering rectal injections the utmost gentleness is requisite, 
especially when a large amount of fluid is to be introduced. Rude 
thrusting of the pipe into the rectum may injure the mucous mem- 
brane, and rapid and forcible dilatation of the bowel will excite an 
imperious desire to go to stool. Too great pressure, in the process of 
irrigation, may cause a rupture of the intestine, especially if its coats 
are softened by disease or penetrated by ulceration. It is possible 
that sudden and forcible distention of the bowel may produce dan- 
gerous cardiac syncope in susceptible subjects. 

The experiments on the cadaver have demonstrated that, although 
the large intestine may be filled with water, no fluid can be made to 
pass the ileo-caacal valve. Notwithstanding these experiments, it has 
been claimed that in the living subject, by the irrigation method, water 
can be forced through the whole length of the intestine. If these ob- 
servations are correct, it is probable that a pathological state of the 
ileo-csecal valve must have existed. 

Foems of Enemata. — Enema Aloes. — ~fy Aloes, 3ij ; potassii car- 
bonat., grs. xv ; mucil. amyli vel decoct, hordei, | x. (B. P.) 

Enema Mag nesii Sulphatis. — r* Magnesii sulphat., 5 j ; ol. olivae, 
| j ; mucil. amyli vel decoct, hordei, % xv. Dissolve the sulphate of 
magnesia in the mucilage, then add the oil. (B. P.) 

Enema Terebinthinw. — 3 01. terebinthinge, f j ; mucil. amyli vel 
decoct, hordei, § xv. (B. P.) 

Enema 01. Ricini et Terebinthince. — t} 01. terebinthini, J ss ; ol. 
ricini, § jss ; ovi, j ; decoct, hordei vel aq. fervid., § xiv. 

A common domestic enema consists of soap-suds, made somewhat 
more stimulating to the rectum by the addition of turpentine. 

Therapy. — A pint of cold water is a good enema for cases of 
habitual constipation, especially when there are haemorrhoids which 



712, EYACUANTS. 

bleed with every motion. The enema of aloes, in quantity correspond- 
ing to the age of the subject, is an efficient remedy for the destruction 
of ascarides vermiculares. 

The purgative enemata above given are employed to act on the 
large intestine, chiefly by virtue of reflex stimulation, but, in part, ab- 
sorption of the purgative principle takes place, whence it follows that 
they may affect the whole canal. They are used, therefore, as cathar- 
tics, and for the ordinary purposes of these remedies. The purgative 
enemata are not suitable for habitual use. They excite irritation of 
the rectum, which may result in ulceration, ischio-rectal abscess, fistula 
in ano, fissure of the anus, and other serious accidents. 

Irrigation of the bowel is resorted to for the removal of impacted 
fmces, to overcome intussusception, etc. 

Cases of intestinal invagination have been very quickly relieved by 
sudden inflation of the large intestine with carbonic acid. The process 
consists in the injection of a solution of sodium bicarbonate, followed 
by a solution of tartaric acid — about one drachm of each to eight 
ounces of water. The escape of the gas through the sphincter ani 
must be prevented by forcible pressure upon the anus. 

Suppositoria Aloes. — (Aloes and cacao-butter.) Each suppository 
contains about five grains of purified aloes. One of these, introduced 
into the rectum at night, will generally procure one or two evacua- 
tions on the following day. It is not good practice to employ such a 
method of treatment frequently. 

A piece of hard white soap cut into a conical shape, and of a suit- 
able size, is frequently used in domestic practice to relieve the consti- 
pation of infants. The soap suppository thus prepared is carefully 
introduced into the rectum. The habit of a daily evacuation may be 
thus induced. A piece of paper rolled into a conical shape, and dipped 
into oil, may be used instead of the soap suppository. 



ANTHELMINTICS. 

Anthelmintics are remedial agents used to cause the expulsion of 
parasites from the intestinal canal. Vermifuges are remedies which 
expel worms ; vermicides are remedies which kill as well as expel 
worms. Some of these agents act mechanically, as mucuna and pow- 
dered tin ; others are administered in such quantity as to sicken and 
disable the worms, when their expulsion is easily effected : for ex- 
ample, pumpkin-seed emulsion. Others again possess narcotic and 
toxic properties, as turpentine, chenopodium, santonin, etc. 

Anthelmintics are conveniently divided into those employed against 
ascarides vermiculares, those employed against ascarides lumbricoides, 
and those employed against the different varieties of taenia. 



ANTHELMINTICS. 713 

Ascarides vermiculares infest the rectum and large intestine, ex- 
tending up occasionally as high as the ileo-caecal valve ; in females, 
they may also spread into the vagina. As they deposit their ova in 
the folds of the anus, and in the vagina, it is obvious that the parasiti- 
cide, to be effective, must be applied in these situations. 

Infusion of quassia, decoction of aloes, and a weak solution of car- 
bolic acid, are the most frequently-prescribed remedies for the destruc- 
tion of ascarides. If carbolic acid is used, the strength of the injec- 
tion for children should not exceed ten grains to the pint, and it 
should not be retained. Infusion of quassia is at the same time safe 
and effective ; but, when this injection is used, a solution of carbolic 
acid should be applied also, by means of a sponge, to the folds of the 
anus, and, in the case of female children, to the external genitals. If 
the ascarides extend up into the large intestine beyond the sigmoid 
flexure, a dose of santonin and calomel should precede the use of the 
rectal parasiticide. 

REMEDIES USED FOR THE EXPULSION OF ASCARIDES LUMBRICOIDES. 

Mucuna. — Cowhage. The hairs of the pods of Mucuna pruriens. 
This remedy is now rarely if ever used. It is administered in the 
form of electuary, mixed with molasses. A teaspoonful or more of 
the mixture should be administered fasting, and after the action of a 
cathartic. When several doses have been taken a brisk purgative 
should be given. 

When cowhage is applied to the skin it excites intense itching, in- 
flammation in the skin, and pustulation. It has been proposed as a 
counter-irritant, but a more disagreeable one could hardly be conceived. 
It is very irritant to the intestinal mucous membrane, as it is to the 
skin, and an action is speedily set up for its expulsion. When by the 
use of a purgative, and by reason of fasting, intestinal worms are un- 
covered and exposed to attack, it is held that the mucuna-hairs pierce 
the parasites and irritate them, so that their stay in the intestine is 
rendered intolerable. In consequence of the active peristaltic move- 
ments induced by the cowhage, and by the purgative with which it is 
followed, the worms are hurried out with the remaining contents, if 
any, of the intestines. 

Santonica. — Santonica. The unexpanded flowers of Artemisia ma- 
ritima, var. Stechmanniana Besser (Nat. Ord. Composite?). (U. S. P.) 
Semencine, Fr. ; Witrmsamen, Ger. 

Composition. — Resin, malic acid, essential oil, and a crystallizable 
principle {santonin). 

Santoninum. — Santonin. A neutral principle obtained from san- 
tonica. A colorless substance, crystallizing in shining, flattened prisms, 



714 EVACUANTS. 

without smell, and nearly tasteless when first put into the mouth, and 
afterward bitter. It is not altered by the air, but becomes yellow on 
exposure to light. Nearly insoluble in cold water, it is dissolved by 
two hundred and fifty parts of boiling water. It is soluble in forty- 
three parts of cold, or in three parts of boiling alcohol, and in seventy- 
five parts of ether. Dose, gr. ss — grs. v, according to age. 

Trochisci Santonini. — Troches of santonin. (Not official.) (San- 
tonin, 3 ss ; with sugar, tragacanth, orange-flower water, to form four 
hundred and eighty troches.) Each troche contains a half -grain of 
santonin. 

Antagonists and Incompatibles. — We do not possess any satis- 
factory data in regard to the physiological antagonists of santonin. 
When a poisonous dose has been taken the stomach should be emptied, 
and the systemic effects should be treated symptomatically. 

Synergists. — Therapeutically the action of santonin is aided by 
cathartics, especially by calomel. 

Physiological Actions. — In ordinary medicinal doses as used for 
the expulsion of lumbrici, santonin causes no sensible intestinal dis- 
turbance. In considerable doses nausea and vomiting are produced, 
and are followed by colic and diarrhoea. Santonin enters the blood, 
probably, in combination with soda, for, although it has no acid prop- 
erties, it has the power to form such combinations. Santonin, ac- 
cording to Hesse (Fliickiger and Hanbury), is the anhydride of a 
crystallizable acid, which, when heated, is resolved into santonin and 
water. Vision is affected in a remarkable manner. Usually all objects 
appear as if viewed through yellow glass ; but other colors sometimes 
appear, as green, blue, or even red (Gelbsehen, Rose). The chroma- 
topsia is probably due, according to Rose, to the solution of santonin 
in the alkaline serum, and its action on the perceptive centers (vol. 
xviii, page 26). In passing out with the urine santonin imparts a yel- 
lowish, and, when the amount is large, a reddish-purple, hue to this 
fluid. 

In toxic doses santonin produces very decided cerebral effects : 
trembling, vertigo, convulsive movements, tetanoid cramps, stupor, 
cold sweats, dilated pupils, insensibility, etc. 

Therapy. — Cures of amaurosis have been reported from the use 
of santonin, but we possess no exact indications for its administration. 
It is, probably, effective only in functional derangement. The chief 
use of this remedy is for the expulsion of ascarides lumbricoides. It 
is the most effective and pleasant remedy which can be employed for 
this purpose. A convenient form for administration is the troche, or 
it may be prescribed in a powder with calomel. The following is a 
successful plan of using this parasiticide : A laxative in the morning, 
fasting through the day, a dose of santonin and calomel at bedtime, a 
senna-draught on the following morning. 



ANTHELMINTICS. 715 

Authorities referred to : 

Brown, Dr. Dyce. Schmidts Jahrbilcher, vol. el, p. 138. 
Fluckiger and Hanbury. Pharmacographia, p. 347. 
Hermann, Dr. L. Lehrbuch der exper. Toxikologie, p. 383. 
Husemann, Drs. Aug. und Theod. Die Pflanzenstoffe, p. 927. 
Kohler, Prof. Dr. Hermann. Handbuch, vol. ii, p. 1292. 
Rose, E. Vir chow's Archiv, vols, xvi, xviii, xix, xx, xxviii. 

Spigelia. — Pink-root. The rhizoma and rootlets of Spigelia Mart- 
landica Linne (Nat. Ord. Loganiacem). 

Extr actum Spigelian Fluidum. — Fluid extract of spigelia. Dose, 
3 j— I ss. 

Composition. — A bitter, uncrystallizable principle {spigelin ?), vol- 
atile oil, tannic and gallic acid. 

Actions and Uses. — In moderate doses spigelia produces a sensa- 
tion of warmth at the epigastrium, stimulates the intestinal movements, 
accelerates the actiomof the heart, and promotes the cutaneous trans- 
piration. In large doses it causes cerebral effects, vertigo, dimness 
of vision, dilated pupils, convulsions, and insensibility. Many of the 
serious symptoms supposed to have been produced by it in certain 
cases were probably really due to pre-existing cerebral lesions. Cases 
of basilar meningitis, for example, have not unfrequently been con- 
founded with " worm-fever." Any vermifuge, given under these cir- 
cumstances, might seem to have caused the head-symptoms which are 
characteristic of the brain-lesions. 

Spigelia is used only as a vermifuge, and against the round worm, 
for the expulsion of which it has proved to be very efficient. A low 
diet and a brisk cathartic should precede the use of this remedy. The 
best form for administration is the fluid extract of senna and spigelia. 

Authorities referred to : 

Porcher, Dr. F. P. Resources of the Southern Fields and Forests. 
Stille, Dr. Alfred. Therapeutics and Materia Medica. 

Chenopodium. — Worm-seed. The fruit of Chenopodium anthelmin- 
ticum Gray (Nat. Ord. ChenopGdiacew). 

Oleum Chenopodii. — Oil of worm-seed. Dose, gtt. v — gtt. xv. 

Actions and Uses. — The oil of worm-seed is the only preparation 
of the plant now used, and this is rarely employed, in consequence of 
its very disagreeable and characteristic odor and taste. It excites a 
sensation of warmth at the epigastrium, increases the action of the 
heart, and promotes cutaneous, bronchial, and renal secretions. It is a 
diffusible stimulant, and as such may be given with advantage in hys- 
teria and chorea, as a carminative in flatulence, and as an antiperiodic 
in inter mittents. The only use of worm-seed is as a remedy for as- 
carides lumbricoides. It is one of the most efficient of the class. It 



716 EVACUANTS. 

should be given three times a day for two days, and followed by a 
brisk cathartic. An excellent combination for the expulsion of the 
round worm is ten drops of worm-seed oil, and a teaspoonful of fluid 
extract of senna and spigelia. It may also be administered in castor-oil. 

REMEDIES USED AGAINST T^ENLE. 

The success of tamiafuges depends largely upon the preliminary 
treatment. The parasite is imbedded in mucus, its hooklets fixed in 
the mucous membrane. The medicament which is administered for its 
expulsion must come in contact with the scolex. To dislodge a quan- 
tity, however large, of the segments (strobila), although temporary 
relief may follow, will not be permanently curative. The head of the 
parasite must be expelled. 

Before using the tseniaf uge the contents of the intestinal canal must 
be thoroughly evacuated. 

Two days of fasting, some milk and bread only being taken, must 
precede the treatment. 

Aspidium. — Male fern. The rhizoma of Aspidium filix mas Swartz, 
and of Aspidium marginale Willdenow (Nat. Ord. Filices). (U. S. P.) 
Fougere male, Fr. ; Wurmfarnivurzel, Ger. 

Oleo-resina Aspidii. — Oleo-resin of fern. Dose, 3 ss — 3 ij. 

Composition. — A green, fatty oil, volatile oil, resin, tannin, etc. 
The ethereal extract deposits a granular, crystalline substance {Ulieic 
acid), on which the medicinal activity of the drug appears to depend. 

Actions and Uses. — The oleo-resin of filix mas is a very efficient 
remedy for tape-worm, especially the unarmed variety ; but, if suitable 
precautions be taken to insure success, it is quite a certain remedy for 
the armed taenia. The method of Trousseaux and Pidoux is as efficient 
as any (vol. ii, page 1040). On the first day, a strictly milk diet ; on 
the morning of the second day, four grammes (about 3 j) of the oleo- 
resin in four doses, with an interval of a quarter of an hour between 
each ; on the third day, the same quantity at the same intervals, fol- 
lowed by fifty grammes of the sirup of ether, and, a half -hour later, an 
emulsion containing three drops of croton-oil. Kuchenmeister gives 
a number of methods, and Cobbold favors the employment of male 
fern in certain cases. 

Granatum. — Pomegranate. The bark of the root of Piinica gra- 
natum Linne (Nat. Ord. Granitaceae). (IT. S. P.) £corce de ratine 
de grenadier, Fr. ; Granatwurzelrmde, Ger. 

Composition. — Pomegranate-bark contains a principle — pelleterine 
— on which its activity depends. The tannate, an efficient taeniafuge, 
can be given in doses of five grains to one scruple. 

Actions and Uses. — The rind of the fresh root only should be used. 



ANTHELMINTICS. 717 

The best preparation is the decoction, prepared by boiling gently two 
ounces of the bark in a quart of water down to a pint. Of this decoc- 
tion a wineglassful may be given every hour until all is taken. It 
should be preceded by a brisk purgative, and should be taken fasting. 
It produces more or less nausea, borborygmi, intestinal pain, and usu- 
ally purges. If a purgative effect is not caused by it, a brisk cathartic 
should follow. In the author's experience, this is a very certain and 
efficient tseniafuge. Tauret's preparation of unpurified pelleterine, in 
solution, has acted very efficiently in some cases. 

Brayera. — Kousso. The female inflorescence of JBrayera anthel- 
mintica Kunth (Nat. Ord. Rosacea). (U. S. P.) Urayere anthelmin- 
thique, Fr. ; Kussobluthen, Ger. 

HJxtractum Brayerce Fluidum. — Fluid extract of brayera. Dose, 

3 ij— I j- 

Infusum JSrayerce. — Infusion of brayera (six parts to one hundred 
of water). Dose, | iv — | viij — Oj, or more. 

Composition. — Brayera contains an active principle (Jcosin, or 
koussin), which crystallizes in rhombic prisms. Kosin appears to be 
inert of itself, and is active only when combined with the other con- 
stituents of the drug. 

Actions and Uses. — Kousso is used solely as an anthelmintic. 
Opinions vary as to its utility. On the whole, it may be said that the 
first enthusiasm which attended its introduction into practice has died 
away. It brings the segments, but rarely expels the head of the para- 
site. It is necessary to take it in large quantity — half an ounce — 
mixed with water. It is retained with difficulty, and produces much 
intestinal distress. When successful, the worm is brought away with- 
out the action of a purgative. 

Kamala. — Kamala. The glands and hairs from the capsules of 
Mallotus Philippinensis Mueller Arg. (Nat. Ord. Euphorbiacem). 
(U. S. P.) Dose, 3j— 3iij. 

There are no official preparations. A saturated tincture may be 
given, in the dose of one to three drachms. 

Actions and Uses. — It is an orange powder. It causes some nausea 
and griping, usually, but it may operate without producing any un- 
pleasant sensations. It acts as a purgative, and causes the expulsion 
of the worm. If one dose is insufficient, its administration should be 
continued every three hours until five or six doses have been taken. 
Kamala is effective not only against tape-worm, but also against lum- 
brici and ascarides vermiculares. 

Pepo. — Pumpkin-seed. The seed of Cucurbito pepo Linne (Nat. 
Ord. Cucurbitacece). 

Actions and Uses. — This is one of the most efficient remedies which 



718 EVACUANTS. 

we possess against taenia. Two ounces of the fresh seed are pounded 
in a mortar, with a half -pint of Avater, until the husks are loosened and 
an emulsion is made. The mixture is then strained, and the whole 
amount is taken fasting ; but Squibb maintains that all should be taken, 
husks included. If an action of the bowels does not take place in two 
hours, the emulsion should be followed by castor-oil. If success is not 
attained, the dose may be repeated each morning until the parasite is 
produced. Numerous cases of successful use of pumpkin-seed emul- 
sion have been reported. 

The expressed oil, which is bland and unirritating, like almond-oil, 
may be used as a substitute for the seeds. It should be given in the 
dose of a half -ounce, two or more times, and after several hours fol- 
lowed by castor-oil. The rules already given, in regard to preliminary 
treatment, should also be followed. 

Authorities referred to : 

Cobbold, T. Spencer. On Parasites. Also various articles in TJie Medical Times and 
Gazette, IS 75. 

Husemann, Dr. Theodor. Handbuch, op. cit., erster Band, p. 202. 

Kohler, Dr. Hermann. Handbuch der physiologische TJierapeutik, zweiter Band, 
p. 1292. 

Kuchenmeister, Dr. Frederick. On Animal and Vegetable Parasites, Sydenham So- 
ciety, vol. i, p. 147, et seq. 

Stille, Dr. Alfred. Therapeutics and Materia Medica, vol. ii. 

Squibb, Dr. Edward. The Ephemeris, 1883. 



These remedies are employed chiefly for their action on the genito- 
urinary passages. They stimulate the kidneys to increased activity, 
and excite the functions of the pelvic viscera. In excessive quantity, 
or long continued, they may set up inflammation of the kidney, pro- 
duce strangury and bloody urine, excite uterine contractions, and stimu- 
late to an unnatural degree the sexual propensities. They contain an 
essential oil, or principle, which makes its exit by the urinary passages 
and excites local irritation by direct contact. 

Terefointhina. — Turpentine. A concrete oleo-resin obtained from 
Pinus australis Michaux, and from other species of Pinus (Nat. Ord. 
Coniferce). 

Oleum Terebinthinae.— Oil of turpentine. A volatile oil distilled 
from turpentine. (U. S. P.) Essence de terebmthi?ie,Fr.; Terpentinol, 
Ger. Dose, % v — 1 ss. 

Linimentum Terebinthince. — Liniment of turpentine. (Resin ce- 
rate, sixty-five parts ; oil of turpentine, thirty-five parts.) 



URINO-GENITALS. 719 

Antagonists and Incompatibles. — All remedies increasing waste, 
and the vaso-motor depressants, counterbalance the therapeutical ac- 
tions of turpentine. In cases of poisoning the stomach should be 
promptly emptied, and anodynes and demulcents should be adminis- 
tered. Elimination should be favored, and the toxic symptoms treated 
according to the systemic indications. Ozonized oil of turpentine is 
an antidote to phosphorus, preventing the formation of phosphoric acid 
and converting the poison into an insoluble spermaceti-like substance. 
Turpentine worn in a vial about the neck prevents necrosis of the jaw 
and steatosis of organs in workmen engaged in manufactures employ- 
ing phosphorus. 

Syneegists. — The diffusible and alcoholic stimulants favor the 
action of turpentine. 

Physiological Actions. — Turpentine-oil is a limpid, colorless fluid, 
having a strong, peculiar, and diffusive odor, and a hot and pungent 
taste. It is very slightly soluble in water. The oil exposed to the 
air absorbs oxygen (ozone), which it retains with great tenacity. Ap- 
plied to the skin, turpentine causes heat, redness followed by a vesicu- 
lar eruption, and sometimes by intractable ulcerations. A few drops 
produce a sense of heat at the epigastrium, and a large dose (medi- 
cinal) causes intense burning pain, nausea, eructations of the oil, in- 
testinal irritation and purging (usually). Notwithstanding its slight 
solubility in water, turpentine diffuses into the blood with facility, and 
is quickly recognized in the breath, sweat, and urine. The action of 
the heart and arteries is increased by it, the arterial tension rises, and 
a general sense of warmth and exhilaration is experienced. In large 
doses (one or two ounces) vomiting, thirst, and a febrile state, are 
induced ; the muscular strength is diminished, the power of co-ordina- 
tion is impaired ; exhilaration of mind, incoherence of ideas, and ram- 
bling insensibility, follow. In toxic doses there are complete muscular 
relaxation and profound insensibility with abolition of all reflex move- 
ments ; the face is flushed or cyanosed, the pupils usually dilated, and 
the breathing labored and stertorous. All the organs by which tur- 
pentine is eliminated, especially the kidneys, suffer from extreme irri- 
tation when large doses have been swallowed. The skin is usually 
moist, and exhales a turpentine-odor ; the bronchial secretion is in- 
creased, and convulsive coughing is induced ; the urine is scanty and 
bloody, and there is violent strangury. The only fatal cases which 
have been reported have occurred in children (Taylor). From four 
to six ounces have not destroyed life in adults. 

As regards its action on the organs of circulation, the author's 
experiments show that turpentine stimulates the vaso-motor nervous 
system when administered in moderate doses. A large quantity 
quickly exhausts the irritability of the sympathetic ganglia, the action 
of the heart becomes weak, and the arterial tension falls ; the respira- 



700 EVACUANTS. 

tory movements are at first stimulated, but afterward become shallow, 
and carbonic-acid poisoning supervenes. The brains of animals killed 
by turpentine smell strongly of it, and hence it may be concluded that 
it has a direct action on the cells of the cerebral lobes. 

Turpentine has decided antiseptic power. It arrests fermentation 
processes, putrefaction, and is very destructive of minute organisms 
(vibrio, bacteria, etc.). 

The vapor of turpentine inhaled produces nasal and bronchial irri- 
tation, frontal headache, and renal irritation, even bloody urine and 
strangury. 

On post mortem after turpentine-poisoning, violent gastro-intestinal 
irritation, ecchymoses of the air-passages,. congestion of the lungs, and 
hyperemia of the kidneys, are noted. 

Theeapy. — Flatulence may be quickly relieved by a few drops 
(three to five) of turpentine, on a lump of sugar. This remedy is 
especially indicated in flatulence persisting from a paretic state of the 
muscular layer of the bowel. There is abundant evidence to prove the 
curative power of oil of turpentine in chronic intestinal catarrh. It is 
especially indicated when the tongue is dry and glazed, when there is 
tympanitic distention of the bowels, and when the alvine discharges 
consist either of fluid faeces or scybala, mixed with mucus and pale, 
watery blood. It is best administered in an emulsion, with almond- 
oil and opium. Ijt 01. terebinthini, 3 j ; ol. amygdal. express., % ss ; 
tinct. opii, 3 ij ; mucil. acaciae, 3v; aquae laur.-cerasi, § ss. M. Sig.: 
A teaspoonful every three, four, or six hoars. The same remedy, in a 
similar combination, is very effective in acute dysentery after the sub- 
sidence of the more acute symptoms. The following is probably the 
true explanation of its action in these cases : it gives tonicity to the 
vessels, and to the muscular fiber of the intestines ; arrests the putre- 
factive and fermentative processes which take place in the vitiated 
mucus and articles of food, and increases the cutaneous capillary circu- 
lation, thus relieving congestion of internal organs. 

Stimulating enemata are made of turpentine, mucilage, oils, etc. 
These are especially indicated in constipation, and in impaction of 
the rectum. r> 01. terebinthini, 3 ij — ? j ; ol. ricini, § ij ; vitell. ovi 
unius ; decoct, hordei, f viij — Oj. M. Sig.: As an enema. Such in- 
jections are frequently used in tympanitic distention of the large 
intestine, in flatulent colic, in impaction of the caecum, etc. 

A combination of equal parts of turpentine and ether constitutes 
the w r ell-known remedy of Durand for the solution and cure of biliary 
calculi. Notwithstanding the unquestionable utility of this remedy, 
we can not admit with Durand that its efficacy depends on its solvent 
power (Trousseau). During the attack of biliary colic this remedy 
may be administered with a view to its anodyne and antispasmodic 
effect ; but, as Kohler states, it is by no means equal to morphine and 



TTRINO-GENTTALS. 721 

chloral hydrate. In the after-treatment, clinical experience is in favor 
of the occasional administration of Durand's remedy during a course 
of Vichy or Carlsbad water. 

Turpentine is one of the most effective remedies which we possess 
in the treatment of tamice. Full doses ( 3 ss — § ij) are required, and 
the rules for preliminary treatment already laid down (see Anthel- 
mintics) should be adhered to. Turpentine should be combined with 
a purgative, in order to insure prompt cathartic effect. If absorption 
of any considerable part of the turpentine takes place, violent intoxica- 
tion will follow, and irritation of the kidneys, hematuria, and stran- 
gury, will be produced in the efforts at elimination. The oleo-resin 
of filix mas may be combined with turpentine. 1} 01. terebinthinse, 
5 j ; oleo-resinae filicis, 3 j ; vitell. ovi no. ij ; ol. ricini, 3 j. M. Sig.: 
A draught. This is an effective, but by no means an agreeable, mix- 
ture. An ounce each of turpentine and castor-oil may be administered, 
as the cathartic, after the use of the decoction of pomegranate. 

Turpentine being a cardiac stimulant, and an excitant of the capil- 
lary circulation, is contraindicated in hypertrophy of the heart, and 
when advanced atheroma of the cerebral arteries may be presumed to 
exist. It is a serviceable cardiac stimulant when the action of the 
heart is weak, and the arterial tension low. In the passive haemor- 
rhages we possess few agents more generally useful. The indications 
for its use are a condition of debility, relaxation of the vessels, and an 
impoverished condition of the blood. Transudations on the free mu- 
cous surfaces — epistaxis, bronchial hcemorrhage, hcematemesis, intesti- 
nal hcemorrhages, hcematuria — when associated with the state of con- 
stitutional depression defined above, are forms of haemorrhage in which 
turpentine should be used. ^ 01. terebinthirise, 3 iij ; ext. digitalis 
h\, 3 j ; mucil. acaciae, f ss ; aquae menthae pip., 3 j. M. Sig. : A 
teaspoonful every three hours. The hemorrhagic transudations which 
take place in purpura, in scorbutus, and allied states, are also arrested 
by turpentine. It need hardly be stated that active haemorrhage and 
a condition of plethora contraindicate the use of turpentine. 

As a stimulant to the vaso-motor nervous system, turpentine is in- 
dicated in fevers when the action of the heart is feeble, the arterial 
tension low, and the peripheral circulation languid. Ten drops in an 
emulsion is a suitable form, and every two hours is a proper interval 
for its administration in this condition of things. According to G. B. 
Wood, a dry tongue, peeling off in flakes, leaving a glazed surface be- 
neath, is a special indication for the use of turpentine in fevers. The 
intestinal haemorrhage of typhoid may be restrained by turpentine. 

Clinical experience is in favor of the use of turpentine in puerperal 

fever and in yellow fever. The indications for its employment in 

these maladies are just the same as those mentioned above in typhoid. 

Cardiac weakness, depression of the vaso-motor nervous system, a dis- 

47 



72'2 EVACUANTS. 

solved state of the blood, are the conditions requiring turpentine. 
Tympanitic distention of the abdomen is an additional indication in 
puerperal fever. Similarly, turpentine is used in epidemic dysentery, 
traumatic erysipelas, hospital gangrene, etc. In these various states, 
employed with a well-defined conception of its real powers, this remedy 
is more generally serviceable as a stimulant than alcohol. As respects 
the dosage, in febrile diseases, a rule may be formulated as follows : 
for the intestinal complications, small doses frequently repeated (ten 
drops) ; as a stimulant to the vaso-motor nervous system, larger doses 
(t\[ x — 3 ss) at somewhat longer intervals. 

In the article on " Phosphorus " attention has been called to the 
utility of turpentine in poisoning by this substance. 

The physiological effects of turpentine indicate its utility in certain 
disorders of the nervous system. As an enema, turpentine has been 
used for its derivative effect in insolation or sunstroke (Levick, Wood), 
and in cerebrospinal meningitis (Hirsch). So accurate an authority 
as Topinard maintains the utility of this remedy in the cystic compli- 
cations of posterior spinal sclerosis. Turpentine has long been used 
successfully in epilepsy, but in those cases only in which the seizures 
were due to the reflex impression of intestinal parasites (taeniae). Tic- 
douloureux and sciatica, when rheumatic in origin, or when produced 
by fecal accumulations, have been cured by the vigorous use of turpen- 
tine, but we have now other means of treatment more generally useful 
and less disagreeable. 

As turpentine is largely eliminated by the bronchial and renal mu- 
cous membrane, decided effects are produced at these points. In dif- 
fusing outward, a change in the tonicity of the vessels, and in the 
character of the secretions, must necessarily be produced. Clinical 
experience confirms the deductions of theory. In chronic bronchitis, 
with profuse expectoration (bronchorrhoea), especially when the expec- 
torated matters have a fetid odor, turpentine is an excellent remedy 
(Oppolzer). In gangrene of the lung, although it is not curative, it 
acts beneficially in diminishing the fetor. In pneumonia and capil- 
lary bronchitis, when the vital powers are depressed and the peripheral 
circulation is feeble, turpentine is one of the best stimulants which we 
can employ. The depression which occurs during the period of crisis 
in pneumonia, and the condition of purulent infiltration, especially in- 
dicate the use of this remedy. In the so-called humid asthma, and in 
emphysema with profuse bronchial catarrh, good results are obtained 
by the use of turpentine. In these various pulmonary maladies, the ac- 
tion of turpentine is largely local, as already explained, but it should not 
be forgotten that the powerful stimulation of the cutaneous circulation 
which it causes must contribute no small share of the curative action. 

In hydro-nephrosis and pyo-nephrosis turpentine is used as in bron- 
chial catarrh, viz., to alter by actual contact the relaxed condition of 



URINO-GENITALS. 723 

the vessels, and the pathological secretions of the mucous membrane. 
It is, of course, contraindicated during the existence of acute symptoms. 
Chronic catarrh of the bladder is not unfrequently much improved by 
the use of this agent. It is most serviceable in those cases resulting 
from a transference of urethral inflammation, or due to prostatic dis- 
ease. Incontinence of urine, the result of atony of the muscular layer 
of the bladder, is sometimes removed by small doses of turpentine. 
Chronic gonorrhoea, gleet, spermatorrhoea, and prostorrhoea, when the 
discharges peculiar to these maladies are due to a relaxed condition of 
the affected parts, are not unfrequently remarkably benefited by mod- 
erate doses of turpentine. 

External Uses of Turpentine. — The author long ago pointed 
out the fact that turpentine is one of the most efficient applications in 
hospital gangrene. The mortified parts are first removed with the 
scissors, and the remedy is then applied directly to the affected sur- 
face, by means of a piece of cotton cloth saturated with it. Fetor is 
removed and sloughing is arrested, and but little pain attends the 
application. 

Turpentine-stupes are much employed as a local and external means 
of treating internal inflammations. A piece of spongio-piline, or of 
flannel, large enough to cover the affected part, is first moistened with 
hot water, and then a few drops of turpentine (five to ten drops only) 
are sprinkled on it. As very severe smarting, inflammation, and vesi- 
cation of the skin may occur from the application, and be experienced, 
indeed, some time subsequently to the removal of the stupe, care must 
be used not to continue it too long. 

Liniment of turpentine is a convenient counter-irritant in cases of 
myalgia, superficial neuralgia, lumbago, etc. An excellent counter- 
irritant application is made by mixing equal parts of oil of turpentine, 
acetic acid, and liniment of camphor (Stille). The most successful 
treatment of severe burns is by the plan of Kentish, which consists in 
first washing the injured surface with turpentine, and then applying an 
ointment made by mixing basilicon-ointment with turpentine. Ery- 
sipelas has been treated by the same measures by Meigs, and the same 
applications are generally in use in chilblains. 

Inhalations of turpentine-vapor, or atomized turpentine, is an effi- 
cient means of local treatment in chronic laryngeal and bronchial af- 
fections. As a matter of curious therapeutics, it may be mentioned 
that gonorrhoea has been successfully treated by having the patient 
inhale the vapor of turpentine in an apartment filled with it. 

Terebinthene ; Terpine ; Terpinol ; Terebene. 

History and Properties. — The several substances here given 
possess properties entitling them to consideration as derivatives of 
turpentine. 



724 EVACUANTS. 

By the distillation of turpentine with an alkali, a hydrocarbon 
(C 10 H l6 ), which is now designated by our French colleagues by the 
name terebinthene, is produced. This is converted by hydration into 
a solid crystalline body — terpine. When terpine is acted on by an 
acid it is converted into terpinol, so named because it has an oily ap- 
pearance and consistence. Terebene, as known to English-speaking 
therapeutists, is derived from turpentine by the action of an acid 
(sulphuric). 

The dose of the hydrate of terebinthene [terpine) is from five to 
twenty grains ; of terpinol, from two to five grains, or more. Tere- 
bene is given in from five to twenty minims. They are not soluble in 
water, and require alcohol to effect a solution. They can be made into 
an emulsion, or dropped on a lump of sugar, or put into gelatine cap- 
sules. To obtain the best effects of which they are capable, maximum 
doses are necessary. Their effects correspond in general to those of 
turpentine. Their most important uses, also, are in the same direc- 
tion—in the treatment of affections of the mucous membranes — of 
bronchitis, emphysema, capillary bronchitis or broncho-pneumonia, 
asthma, etc. These therapeutical results are for the most part due to 
the local action at the points of elimination — bronchial and renal. The 
same action, therefore, occurs in pyo-nephritis and in the catarrhal 
process affecting the bladder. Dujardin-Beaumetz, in arranging these 
medicaments in the order of their relative utility, places them thus : 
in bronchial affections, terpinol or terebene is first, but in renal affec- 
tions terebinthene or terpine. 

Given in full medicinal doses these remedies cause a feeling of 
warmth in the epigastric region, and, if no local irritation exists, rather 
stimulate appetite and digestion than impair them. They possess car- 
minative properties, and cause the expulsion of gases. Secretion is 
increased and the peristaltic movements are also somewhat accelerated. 
In respect to these actions, these remedies have properties correspond- 
ing to those of turpentine. When the tongue is dry and exfoliates 
in large flakes, the terebinthinate preparations act favorably. When 
intestinal haemorrhage takes the form of oozing from a large surface, 
the general condition being one of debility, and the blood impover- 
ished, terebinthene will no doubt act favorably. 

The authorities who have contributed most to the existing knowl= 
edge are as folio ws : 

Da Costa, Dr. J. M. The American Journal of the Medical Sciences, January, 1866 ; 

Dujardin-Beaumetz. Lectures on New Medicaments. 

In England. Dr. Murrell. The British Medical Journal, 1S86, etc. 

Lepine, Prop. Bui. Gen. de Therapcutique and Journal de Therapcutique for 1SS6, 

Levick, Dr. R. J. The American Journal of the Medical Sciences, January, 1S69. 

Little, Dr. The Practitioner, vol. ix, p. 3G9. 



URINO-GENITALS. 725 

Oppolzer, Prof. Allgem. Wiener med. Zeit, No. xxxiii, 1866. 

See, Prof. G. Ibid. 

Topinard, Dr. L. Be VAtaxie Zocomotrice, etc., Paris, 1864. 

Trousseau, Dr. A. Clinique Medicate de V Hotel Dieu. 

Trousseau et Pidoux. Traite de Therapeuiique et Matiere Medicate, vol. ii, p. 802. 

Wood, Dr. George B. The Practice of Medicine, fourth edition, vol. i, p. 346. 

Copaiba. — Copaiba. The oleo- resin of Copaifera Langsdorfii 
Desfontaines, and of other species of Copaifera (Nat. Ord. Legu- 
minosce, Papilionacem). Baume de copahu, Fr. ; Copaw a- Balsam, 
Ger. Dose, TT[ x — 3 j. 

Massa Copaibaz. — Mass of copaiba. (Copaiba, 94 parts ; magne- 
sia, 6 parts.) 

Oleum Copaibm. — Oil of copaiba. A volatile oil distilled from 
copaiba. Dose, tti, v — 3 ss. 

Besina Copaibaz. — Resin of copaiba. The residue left after dis- 
tilling off the volatile oil from copaiba. Dose, gr. j — gr. v. 

Composition. — Balsam of copaiba differs from the true balsams in 
not containing cinnamic acid. It is an oleo-resin, the volatile oil con- 
stituting from forty to sixty per cent. The oil of copaiba is isomeric 
with the oil of turpentine, but it differs in some of its physical prop- 
erties from the latter. The resin has an acid reaction, and has been 
entitled copaivic acid. 

Actions and Uses. — Copaiba has a nauseous, bitter, and very dis- 
agreeable taste. When taken into the stomach it causes some heat, 
and offensive eructations, tasting of the balsam, occur. Indigestion, 
heaviness at the epigastrium, anorexia, are frequently produced by it, 
and diarrhoea is an occasional result of its use. It is, therefore, a gas- 
trointestinal irritant. Both the oil and the resin diffuse into the blood. 
The various excretions, the sweat, the bronchial mucus, the urine, ac- 
quire a peculiar and rather a fragrant odor from its presence. This 
odor is especially observable in the urine, and in this secretion the resin 
may be discovered also by the addition of nitric acid, which causes a 
precipitate. At the points of elimination more or less irritation is pro- 
duced, and, as a result of the irritation, increased secretion ; hence co- 
paiba is said to be diaphoretic, diuretic, and expectorant. Very serious 
injury may be done to the gastro-intestinal canal, and to the kidneys, 
by the use of this agent in large doses. The author has known gastro- 
intestinal catarrh to persist many months after a course of copaiba, and 
he has reason to believe that desquamative nephritis and fibroid kid- 
ney have resulted from its free administration for a lengthened period. 
While small doses of balsam will increase the gross amount of urine 
and of the solid contents, large doses will actually cause a diminution 
in the amount both of water and solids by setting up renal irritation. 
Although, during a course of balsam, nitric acid causes a precipitation 



726 EVACUANTS. 

of the resin, which is dissolved on the addition of alcohol, the author 
has, in several instances at least, detected albumen in the urine of those 
taking this remedy. 

Copaiba is contraindicated when a condition of gastro-intestinal ir- 
ritation and hyperaernia of the kidneys exist. 

Gonorrhoea is the disease to which copaiba is most especially 
adapted. Its administration should not be begun, however, until after 
the acuter symptoms have subsided. As the action of the remedy is 
local or direct, acute symptoms are rather aggravated by it. Combina- 
tion with liquor potassae promotes its curative action by diminishing 
the acidity, and hence the irritation produced by the urine. Combina- 
tion with agents acting synergistically, as oils of cubebs and sandal- 
wood, is also desirable. The following formulae exemplify these thera- 
peutical facts : ^ Copaibae, pulv. cubebae, aa § ij ; aluminis, f j ; opii, 
gr. v. M. Sig. : One to two drachms, night and morning. IJ, 01. 
copaibae, ol. cubebae, ol. santal. flay., aa 3 j ; magnesiae, 3 ij. M. Ft. 
pil. no. lx. Sig. : Two pills every four hours. 

In chronic catarrh of the bladder, copaiba is useful by virtue of the 
local action which it has upon the mucous membrane. Its nauseous 
taste and the gastric and renal irritation produced by it are serious 
objections to its use in a malady which requires the persistent and 
long-continued application of remedies in order to even moderate its 
symptoms. 

For acute bronchitis after the subsidence of the fever, for chronic 
bronchitis with profuse secretion, for bronchorrhoea (dilated bronchi), 
copaiba is the most generally serviceable expectorant. Unfortunately, 
it is so disagreeable that it is difficult to overcome the repugnance of 
patients. Even when administered in capsules, or in pill-form with 
magnesia, the nauseous eructations excite disgust. IJ, Copaibae, bal- 
sam, tolutan., pulv. acaciae, aa § ss ; acid, sulphur, aromat., 3 ss ; aquae 
destil., J vj. M. Sig. : A tablespoonful, two or three times a day, in 
chronic bronchial affections, whooping-cough, etc. IJ Copaibae ; syrp. 
tolutan., aa § ss ; aquae mentha? pip., § ij ; spirit, etheris nitrosi, § j. 
M. Sig. : A teaspoonful every four hours. 

Excellent results have been obtained from the use of copaiba in 
dropsy, especially in ascites. In these cases it acts powerfully on the 
kidneys. Wilks holds that copaiba-resin is a more efficient diuretic 
than the balsam. IJ Res. copaibae, 3 iij ; alcohol., 3 v ; spirit, chloro- 
formi, 3 j ; mucil. acaciae, | ij ; aquae ad 3 xij. M. Sig. : A table- 
spoonful ter in die. It is conveniently given in pill-form also. 

In some subjects possessed of an irritable skin, copaiba produces an 
eruption of urticaria, or roseola, or erythema. This is not in conse- 
quence of a selective action on the skin, but is the result merely of the 
gastro-intestinal disturbance. Influenced, probably, by this fact that 
an eruption may be caused by copaiba, this agent has been proposed 



UEINO- GENITALS. 727 

as a remedy in certain cutaneous diseases — in those characterized by- 
torpor of the peripheral circulation. 

Authorities referred to : 

Bernatzik, Prof. Dr. W. Prag. Vjhrschr., c, p. 239. Schmidt's Jahrbucher, vol. 
cxli, p. 278. 

Fluckiger and Hanbcry. Pharmacographia, p. 200, et seq. 

Gubler, Dr. A. Commentaires IVierapeutiques, p. 86, et seq. 

Husemann, Dr. Theodor. Handbuch, p. 1195, et seq. 

Kohler, Dr. Hermann. Handbuch, erste Halfte, p. 3*70, et seq. 

Trousseau et Pidoux. Traite de Therap. et de Mat. Med., vol. ii. 

Weikart, Dr. H. Archiv der Heilk., i, ii, p. 176, 1860. Schmidt's Jahrbucher, vol. 
cvi, p. 162. 

Wilks, Dr. S. The Lancet, 1873, vol. i, p. 410. 

Cubeba. — Cubeb. The unripe fruit of Gubeba officinalis Miquel 
(Nat. Ord. Piperacece). (U. S. P.) Cubebes, Fr. ; Cubeben, Ger. 

Extractum Cubebce Fluidum. — Fluid extract of cubeb. Dose, 3 ss 
— 3 ij- 

Oleum Cubebce. — Oil of cubeb. Dose, tti v — 3 ss. 

Oleo-resina Cubebce. — Oleo-resin of cubeb. Dose, t\[ v — 3 ss. 

Tinctura Cubebce. — Tincture of cubeb. Dose, 3 ss — 3 ij. 

Trochisci Cubebce. — Troches of cubeb. 

Composition. — Cubeb contains a volatile oil which varies in pro- 
portion from six to fifteen per cent. It is polymeric with oil of turpen- 
tine. This volatile oil separates in the cold into two distinct substances 
— a camphoraceous substance (cubebene), and a liquid portion (cubeben). 
Besides these, a neutral crystallizable principle (cubebin) has been iso- 
lated. Cubeb also contains a resin, divisible into two distinct sub- 
stances, an indifferent portion and an acid {cubebic acid). The thera- 
peutical properties of the drug reside chiefly, if not exclusively, in the 
oil and resin, hence the oleo-resin is an efficient preparation. 

Actions and Uses. — The taste of cubeb is aromatic, pungent, and 
somewhat camphoraceous. In the stomach it excites a sensation of 
warmth, and, in moderate doses, promotes the appetite and the diges- 
tive capacity. In considerable doses it is laxative, and produces a feel- 
ing of heat and irritation about the rectum. Ingested in a large quan- 
tity, cubeb sets up a gastro-intestinal catarrh, and may even cause acute 
inflammatory symptoms. The active principles diffuse into the blood. 
The action of the heart and vascular system is increased by cubeb, the 
surface becomes warm and perspiring under its use, and the bronchial 
and urinary secretions are more abundant. The odor of cubeb is im- 
parted to the breath and to the urine, and the resin may be precipi- 
tated from the urine by the addition of nitric acid. As explained in 
the previous article (Copaiba), the resin precipitated by nitric acid re- 
sembles albumen, but differs from the latter substance in being soluble 
in alcohol. 



728 EVACUANTS. 

Cubeb stimulates the venereal appetite in man, and promotes the 
catamenial flux in women. 

Finely-powdered cubeb is an efficient local application in chronic 
nasal catarrh. It is blown into the nares by an insufflator. It gives 
considerable relief also in hay-asthma, when there is no fever, and the 
secretion of the nasal mucous membrane is profuse and watery. Pow- 
dered cubeb is useful as a topical application when the mucous mem- 
brane of the fauces is relaxed, or the seat of chronic inflammation (fol- 
licular pharyngitis). The official cubeb- troches are employed by sing- 
ers and public readers, to maintain the tonicity of the mucous mem- 
brane and to prevent or relieve hoarseness. 

Cubeb may also be used, in small doses, to promote secretion and 
increase digestion in cases of atonic dyspepsia. Chronic catarrh of the 
colon and rectum, with a relaxed condition of the mucous membrane 
and of the inferior hemorrhoidal vessels, may be removed by cubeb. 
Sometimes these cases take the form of a mucous dysentery. 

The most important application of cubeb is in the treatment of 
gonorrhoea. Unlike copaiba, it may be administered with good effect 
during the acute stage. The best results are obtained from a mixture 
of the two agents. Catarrh of the bladder, prostorrhoea, spermator- 
rhoea, are maladies in which cubeb may be employed with more or less 
advantage. When the sexual appetite is weak, and the erections fee- 
ble, cubeb will sometimes, if the troubles are functional, remove them. 

Irritability of the bladder, nervous or functional in character, espe- 
cially as it occurs in women, is generally relieved by cubeb ; but can- 
tharides is a more efficient remedy for this troublesome affection. 

In chronic bronchial affections, with profuse expectoration, cubeb 
has a remedial effect similar to that possessed by copaiba, and is useful 
under the same conditions. 

Piper. — Black pepper. The unripe berries of Piper nigrum Linne 
(Nat. Ord. Piper •aceas). (U. S. P.) Poivre noir, Fr. ; Schwarzer 
Pfeffer, Ger. 

Composition. — Pepper contains a resin and an essential oil, and a 
neutral crystallizable principle (piperin). 

Oleo-resina Piperis. — Oleo-resin of black pepper. This contains the 
active constituents of pepper, and is an eligible preparation. Dose, 

m j— m v. 

Piperina. — Piperin. A proximate principle of feebly alkaloidal 
power, prepared from pepper, and occurring also in other plants of the 
natural order Piperaceaz. Colorless, or pale yellowish shining, four- 
sided prisms, permanent in the air, odorless and almost tasteless when 
first put in the mouth, but on prolonged contact producing a biting 
sensation. It has a neutral reaction, is almost insoluble in water, but 
soluble in thirty parts of alcohol at 60° Fahr. Dose, gr. j — gr. x. 



URINO-GENITALS. 729 

Capsicum. — Capsicum. The fruit of Capsicum fastigiatum Blurae 
(Nat. Ord. Solanacece). (U. S. P.) Poivre cVInde, Fr. ; Spanischer 
Pfeffer, Ger. 

Composition. — The acrid, pungent qualities of capsicum are due to 
a peculiar substance (capsicin), a thick, yellowish -red liquid. Felle- 
tar, whose observations have been confirmed by Fliickiger, has isolated 
a volatile alkaloid having the odor of conine. 

Mctractum Capsici Fluidum. — Fluid extract of capsicum. Dose, 
m v— 3 j. 

Oleo-resina Capsici. — Oleo-resin of capsicum. Dose, n\, j — ttj, v. 

Tinctura Capsici. — Tincture of capsicum. Dose, v\ x — 3 j. 

Actions and Uses. — Notwithstanding black and red pepper belong 
to different orders, they are closely related therapeutically and in their 
physiological actions. They may with propriety be considered together. 

When applied to the skin, pepper excites redness, heat, and super- 
ficial inflammation. Red pepper, if in contact with the skin a suffi- 
cient length of time, will produce vesication. It also causes great irri- 
tation of the mucous membrane. It has a hot, pungent, and rather 
acrid taste, and increases the flow of saliva. In the stomach a sensa- 
tion of warmth is produced by it, the secretions are more abundant, 
digestion is more active, and the appetite is promoted. In an exces- 
sive quantity gastritis may be produced. The intestinal secretions are 
no doubt increased, and the alvine evacuations rendered more easy and 
copious. 

The action of the heart and arteries is increased by pepper, a sub- 
jective sensation of warmth is experienced throughout the system, and 
cutaneous transpiration becomes more abundant. Elimination takes 
place chiefly through the kidneys. The flow of urine is increased, 
micturition is more frequent, and more or less vesical tenesmus occurs. 
Decided aphrodisiac effects are produced by red pepper. 

The tincture of capsicum may be usefully employed as a stomachic 
in atonic dyspepsia. It is especially indicated in the dyspepsia of 
chronic alcoholism, when there are present trembling and insomnia. 
Flatulent colic may be relieved by capsicum, especially when this dis- 
order occurs in hysterical subjects. The author has seen excellent re- 
sults from the use of this remedy in the dyspepsia and flatulence of 
hypochondriacal subjects, and of women at the climacteric period. 

Capsicum is an excellent addition to beef -tea when this aliment is 
administered in fevers, and other low conditions of the system. The 
tincture may be employed under the same circumstances as a cardiac 
stimulant. Piperin has been used in cholera as a stimulant, local and 
general, and in low conditions of the system from any cause except 
gastro-intestinal inflammation. At one time it was much prescribed 
in malarial fevers as an adjunct to quinine chiefly, and antiperiodic 
powers were ascribed to it ; but such views are no longer entertained 



?30 EYACUANT8. 

The evidence is conclusive that capsicum quiets restlessness and 
induces sleep in delirium tremens. It maybe administered mixed with 
beef -tea or other animal broths, or thirty grains made into a bolus, 
with sirup or honey, may be given. As capsicum belongs to the fam- 
ily Solanacece, and as Felletar discovered in it a volatile alkaloid, a ra- 
tional explanation is afforded of its action on the cerebrum. Accord- 
ing to Ringer, the tincture of capsicum is the best substitute for the 
stimulant when an attempt is made to break the alcohol-habit. It 
is also very serviceable in the treatment of the opium-habit. The good 
effect of the remedy in these cases is in part due to its action as a 
stomachic stimulant, and partly, doubtless, to its cerebral effects. 

The oleo-resins of black and red pepper have been used with good 
results in the treatment of intermittent fever. They are useful chiefly 
as adjuvants to more efficient remedies. 

Capsicum is coutraindicated in all acute affections of the genito- 
urinary apparatus. In chronic parenchymatous nephritis it checks the 
waste of albumen. In chronic pyelitis, chronic cystitis, and prostor- 
rhoea, it has a beneficial effect ; but, although similar in action to, it 
is less efficient than, cubeb. Excellent results are often obtained from 
it in functional impotence, and in spermatorrhoea from deficient tone. 
In these genito-urinary maladies, the oleo-resin is the best preparation 
for administration. 1^, Oleo-resinse capsici, 3j ; ergotin (aq. ext.), 
3 ij. M. Ft. pil. no. xx. Sig. : One three times a day. 

A capsicum-plaster is a mild counter '-irritant. The infusion is em- 
ployed as a gargle in tonsillitis, diphtheria, and scarlet fever. As it is 
a very irritating application, its use should be restricted to cases char- 
acterized by a low grade of action. 

Juniperus. — Juniper. The fruit of Juniperus communis Linne 
(Nat. Ord. Coniferaj). (U. S. P.) Baies de genievre, Fr. ; Wach- 
holderbeeren, Ger. 

Infusum Juniperi. — Infusion of juniper ( § j — Oj). Dose, 5 ss — 
I ij. (Not official.) 

Oleum Juniperi. — Oil of juniper. Dose, v\ v — f\[ xx. 

Spiritus Juniperi Compositus. — Compound spirit of juniper. (Oil 
of juniper, 10 parts ; alcohol, 3,000 parts ; water, sufficient to make 
5,000 parts ; oils of caraway and fennel, each one part.) Dose, § ss 

Spiritus Juniperi. — Spirit of juniper. (Oil of juniper, 3 parts ; 
alcohol, 97 parts.) Dose, 3j — | j. 

Composition. — Juniper contains a volatile oil, upon which its me- 
dicinal effects chiefly depend. A non-cry stallizable principle (jimi- 
perine) exists in the berries in very small quantity. It contains also 
formic, acetic, and malic acids. 

Actions and Uses. — Juniper increases the appetite and digestion, 



URINO-GEXITALS. 731 

but in overdoses will disorder the stomach. The volatile oil diffuses 
into the blood with facility. Increased action of the heart and of the 
arteries, a subjective sensation of warmth, diaphoresis, and diuresis, 
are produced by it. 

The oil is eliminated by the kidneys chiefly, and imparts an odor 
of violets to the urine. It powerfully stimulates the renal functions, 
and in large doses causes strangury and bloody urine. It may set up 
a high degree of irritation of the kidneys, leading to suppression and 
ursemic intoxication. In common with the other remedies of this 
group, juniper excites the venereal appetite; in large doses may cause 
priapism, and in women promotes the menstrual flow. 

The principal use of juniper is as a diuretic. It is contraindicated 
in acute affections of the kidneys. It is largely employed as a diuretic 
in cardiac and renal dropsy. The infusion is an excellent vehicle for 
the exhibition of saline diuretics in these affections. The oil of juniper 
acts similarly to, and is indicated under the same conditions as, tur- 
pentine in chronic pyelitis, chronic cystitis, gleet, prostorrhoea, etc. 
Diuretic effects may be obtained by inhalation of the vapor of the oil. 
For this purpose a few drops may be put into hot water, and the vapor 
be inhaled. 

The emjiyreumatic oil of juniper (oleum cadinum), obtained by de- 
structive distillation from Juniperus oxycedrus, is a thick, black liquid, 
similar in appearance to and smelling like common tar. It is much 
employed as a local application in chronic eczema, impetigo, ichthyosis, 
psoriasis, acne rosacea, etc. It is usually combined with German soft- 
soap. r>, Alcoholis, saponis mollis, ol. cadini, aa § j ; ol. lavendula?, 
3 jss. M. I£ 01. juniperis empy. (ol. cadini), saponis mollis, aa 3 j ; 
ol. lavend., 3 ss. M. Sig. : Ointment, fy 01. juniperis empy., 3 j — 
3* j ; sevi, § ss ; adipis, f j. M. Sig. : Ointment. 

Erigeron. — Erigeron. The leaves and tops of Erigeron heterophyl- 
lum, and of Erigeron Philadelphicum. (Pharm. 70.) 

Erigeron Canadense. — Canada erigeron. 

Oleum Erigerontis Canadensis. — Oil of Canada erigeron. Dose, 
HI v — v\ x. 

Actions and Uses. — Erigeron possesses a diuretic property to a 
slight extent. Canada erigeron is the more active, and contains a 
much larger proportion of volatile oil. The actions and uses of the 
oil are the same as the oil of turpentine, but the latter is the more 
efficient remedy. The oil of Canada erigeron has a local reputation 
in Philadelphia as an haemostatic agent. It is said to be effective 
in menorrhagia, and cases of intestinal haemorrhage arrested by it 
have been reported. It is adapted only to the treatment of passive 
haemorrhages, and is probably less curative than turpentine in these 
cases. 



73'2 EVACUANTS. 

Buchu. — Buchu. The leaves of Barosma betidina and of other 
species of Barosma (Nat. Ord. Rutacece). (IT. S. P.) Feuilles de bucco, 
Fr. ; Bukubliitter, Ger. 

Infusum Buchu. — Infusion of buchu ( \ j — Oj). Dose, § ss — § ij. 
(Not official.) 

Extraction Buchu Fluidum. — Fluid extract of buchu. Dose, v\ x 
-3j. 

Composition. — Buchu contains a volatile oil in the proportion of 
about 1*5 per cent. This volatile oil consists of a crude oil and a 
camphor — barosma camphor. The latter has a nearly pure peppermint 
odor. The existence of barosmin, so called, is doubtful. 

Uva Ursi. — Uva ursi. The leaves of Arctostaphylos uva ursi 
Sprengel (Nat. Ord. Ericaceae). (U. S. P.) Feuilles de busserole, 
Fr. ; Bdrentraubenbldtter, Ger. 

Decoctum Uvce Ursi. — Infusion of uva ursi ( § j — Oj). Dose, § ss 
— | ij. (Not official.) 

Extractum Uvce Ursi Fluidum. — Fluid extract of uva ursi. Dose, 
3 ss— 3 ij. 

Composition. — Uva ursi contains a bitter, neutral, crystallizable 
substance, arbutin ; a very bitter amorphous principle, ericolin ; and 
a tasteless, crystallizable, neutral principle, ursone. It is rich in gallic 
and tannic acids. 

Pareira. — Pareira brava. The root of Chondodendron tomentosum 
Ruiz et Pavon (Nat. Ord. Menispermacece). (IT. S. P.) Racine de 
pai-eira-brava, Fr. ; Griesiourzel, Ger. 

Infusum JPareirw. — Infusion of pareira brava ( § j — Oj). Dose, 
I ss _ I ij. (Not official.) 

Extractum Fareirm Fluidum. — Fluid extract of pareira. Dose, 
3 ss— I ij. 

Composition. — It contains a principle, buxin, but it is not known 
whether this is the active ingredient. 

Chimapllila. — Pipsissewa. The leaves of Chimaphila umbellata 
Nuttall (Nat. Ord. Ericacece). 

Decoctum ChimdphUce. — Decoction of chimaphila. Dose, 3 ss — ■ 
I ij. (Not official.) 

Extractum Chimaphilce Fluidum. — Fluid extract of chimaphila. 
Dose, 3 ss — 3 ij. 

Composition. — Pipsissewa contains a crystallizable principle, chi- 
maphilin, tannic acid, extractive matters, etc. 

Scoparius. — Broom. The tops of Sarothamnus scoparim Koch 
(Nat. Ord. Leguminosce). (U. S. P.) Gentt a balais, Fr.; Pfriemen- 
Jcraut, Ger. 



URINO-GENITALS. 733 

Composition. — Scoparius contains an indifferent or somewhat acid 
crystallizable principle, scoparin, and an oily, colorless, liquid alkaloid, 
sparteine. The latter has very decided basic qualities, and agrees 
with conine and nicotine in being constituted without oxygen. Its 
actions and uses as a cardiac remedy have been given elsewhere, in 
connection with remedies therapeutically cognate. Here scoparius as 
a diuretic comes under consideration. 

Actions and Uses. — Buchu, uva ursi, pareira, pipsissewa, and sco- 
parius, form a group of diuretics with properties in common. They 
are tonic, astringent diuretics. They promote appetite and digestion, 
and restrain intestinal movements, except pareira, which has rather a 
laxative action. Their active constituents diffuse into the blood and 
are eliminated by the kidneys. In passing over the genito-urinary 
tract these principles act topically upon the mucous membrane. As a 
rule they are actively diuretic ; that is, they increase the amount of 
urinary water. Pipsissewa and scoparius are rather more actively diu- 
retic than buchu and uva ursi, and hence are more useful in dropsy. 
By English physicians generally, and notably the late Dr. Pereira, sco- 
parius is held in much esteem as a remedy for dropsy. It is adapted 
especially to the treatment of cardiac dropsy, and the general anasarca 
of chronic parenchymatous nephritis, but is inadmissible in acute af- 
fections of the kidney. Our indigenous remedy, pipsissewa, may be 
substituted for scoparius in the treatment of dropsy. 

Buchu, uva ursi, and pareira, are more particularly useful in chronic 
pyelitis, catarrh of the bladder, chronic gonorrhoea, etc. ; and of these 
the most efficient, probably, is buchu. The fluid extract is the most 
eligible form in which these remedies can be administered. 

Carota. — Carrot-seed. The fruit of Daucus earota. The wild car- 
rot. (Pharm. 70.) 

The seeds of carrot have a hot, pungent, and bitter taste, due to a 
volatile oil which they contain, and to which their medicinal activity is 
due. As they impart their virtues to water, an infusion of the seeds 
is an eligible form in which to administer the remedy. Carrot-seeds 
act similarly to juniper, and produce diuresis, augment the menstrual 
flux, and cause aphrodisiac effects in the male. 

Taraxacum. — Dandelion. The root, gathered in the autumn, of Ta- 
raxacum dens-leonis Desfontaines (Nat. Ord. Composite). (U. S. P.) 
Pissenlit, Fr. ; Lowenzahnwurzel, Ger. 

Extractum Taraxaci. — Extract of taraxacum. Dose, gr. v — 3j. 

Infusum Taraxaci. — Infusion of taraxacum ( 3 ij — Oj). Dose, 
f ss — 1 ij. (Not official.) 

Extractum Taraxaci Fluidum. — Fluid extract of taraxacum. Dose, 



?34 EVACUANTS. 

Composition. — According to Kromayer, taraxacum contains tarax- 
aci?ie, an amorphous, intensely bitter principle, and a crystalline sub- 
stance, taraxacerine. Nothing is definitely known as to the action of 
these substances. 

Actions and Uses. — Taraxacum possesses the properties of a sim- 
ple bitter, in that it promotes the appetite and digestion. It has 
been long held, both popularly and professionally, to possess the power 
to promote the flow of bile. Recent investigations have demonstrated 
the inaccuracy of these opinions. It is a mild laxative, and as such, 
doubtless, may cause by reflex stimulation an emptying of the gall- 
bladder. It is a diuretic, although not a very active one. It is still 
prescribed as a laxative in catarrhal jaundice, in ascites from hepatic 
disease, and in dyspepsia and indigestion associated with torpor of the 
liver. By German physicians, muriate of ammonia and dandelion are 
frequently associated together in the treatment of the affections above 
named. Taraxacum is occasionally used as a diuretic in dropsy, but 
its utility is very limited. 

The fluid extract of taraxacum is a good vehicle for the administra- 
tion of such remedies as the muriate of ammonia and quinine, the taste 
of which it somewhat covers. 

Scilla. — Squill. The bulb of Jlrginea scilla Steinheil (Nat. Ord. 
Liliacem). (U. S. P.) Ognon marin, Fr. ; Meerzwiebel, Ger. 

Acetum Scillaz. — Vinegar of squill ( § iv — Oij.) Dose, ttj, xx — 3 j- 

Syrupus Scillte. — Sirup of squill. Dose, 3 ss — 3 j. 

Syrupus ScillcB Compositus. — Compound sirup of squill. Hive- 
sirup. This preparation contains squill, senega, and tartar-emetic, the 
last named in the proportion of one grain to the ounce. Dose, fit v — 3 j. 
This is a very active preparation, due chiefly to the tartar-emetic. 

Extr actum Scillai Fluidum. — Fluid extract of squill. Dose, t\[ ]— 
m v. 

Tinctura Scilla?. — Tincture of squill. Dose, -q, v — 3 ss. 

Composition. — The important constituent of squill is an acrid, bit- 
ter principle, scillitin, or skulein — which has not yet been isolated. 
According to Schroff, scillitin is a glucoside, and the active principle 
is an acrid, non- volatile substance (Fltickiger and Hanbury). 

Actions and Uses. — The taste of squill is bitter and somewhat 
acrid. It is an irritant to the mucous membrane, and excites nausea, 
vomiting, and purging, when introduced into the stomach in a suffi- 
cient dose. Very violent gastro-enteritis may be produced by its 
incautious administration in large doses. A state of hyperemia or 
inflammation of the gastro-intestinal mucous membrane, therefore, 
contraindicates its use. 

The active constituents of squill diffuse into the blood. Its sys- 
temic effects are produced by application to the external integument. 



URINO-GENITALS 735 

Paralysis and convulsions are induced in warm-blooded animals by 
toxic doses ; and similar cerebral symptoms occur in man, in addition 
to the phenomena which usually attend the action of an irritant poison. 
In ordinary medicinal doses squill increases the bronchial mucus and 
facilitates expectoration. In toxic doses rapid breathing has usually 
occurred. It is highly probable that a portion of the active constituents 
of squill is eliminated by the broncho-pulmonary mucous membrane. 

Squill stimulates the functions of the kidneys and increases the 
urinary discharge when used in medicinal doses, but in excessive 
quantity it excites violent inflammation, with strangury and bloody 
urine. Suppression of urine may be a result of its irritating action on 
the kidneys. 

The use of squill is confined to its expectorant and diuretic effects. 
The acetmn and syrupus scillce enter into the composition of expec- 
torant mixtures employed in the treatment of catarrh of the bronchial 
tubes, after the subsidence of acute symptoms, and the chronic forms 
of the disease. Squill is more particularly indicated when the sputa 
are tenacious, and are coughed up with difficulty. Ipecacuanha is ad- 
vantageously combined with it in the more recent cases. £> Acet. 
scillae, | ss ; extract, ipecac, fluid., 3 ss ; tinct. opii deod., 3 j ; syrup, 
tolutan., 3 x. M. Sig. : A teaspoo?if id every two, three, or four hours. 
I£ Scillse, ipecac, aa, gr. vj ; ext. hyoscyami, gr. iij ; morphinae sulph., 
gr. ss — gr. j. M. Ft. pil. no. xij. Sig. : One pill every four hours. 
In chronic bronchitis with emphysema or dilated right cavities of the 
heart, squill is better associated with the stimulating expectorants, 
ammoniac, asafoetida, benzoin, etc. ^ Syrup, scillse, § ss ; tinct. opii 
camphor., 3 ij ; ammoniac, 3 ss ; syrup, tolu., 3 x. M. Sig. : A tea- 
spoonful as necessary. Squill is an improper remedy when there are 
present fever and an acute inflammatory condition of the air-passages. 

Squill is a very effective diuretic. Since in overdoses it will pro- 
duce great irritation of the kidneys, it is inadmissible in acute affec- 
tions of these organs. In dropsy caused by any of the chronic dis- 
eases of the kidneys, squill must be used with caution. As a diuretic 
this remedy is more especially useful in cardiac drcpsy. It may be 
combined with digitalis or the saline diuretics. ^ Infus. digitalis, 
I iijss; acet. scillse, § ss. M. Sig.: A tablespoonful two or three times 
a day. ^ Digitalis, 3j; scillse, gr. x ; ext. colchici acet., 3j. M. Ft. 
pil. no. xx. Sig. : One pill every four or six hours. When ansemia is 
present, iron may be added to the above formula. Ijt. Acet. scillse, 
I ss ; liq. potassii citratis, | iijss. M. Sig. : A tablespoonful every 
four hours. 

Authorities referred to : 
Flttckiger and Hanbury. Pharmacographia. 
Husemann, Dr. Theod. Handbuch, zweiter Band, p. 1175. 
Kohler, Dr. Hermann. Handbuch, p. 515. 



736 EVACUANTS. 

Petroselinum. — Parsley-root. The root of Petroselinum sativum. 
(Pharm. 70.) (Not official.) 

Composition. — The most important constituent of parsley is apioi, 
an oily, non-volatile, yellowish liquid, having a distinctive odor and an 
acrid taste. It contains, also, a gelatinous substance, apiine (pectin ?), 
and a volatile oil. 

Actions and Uses. — Petroselinum has a hot, pungent taste, with 
an after acrid sensation. It is somewhat laxative — a property, doubt- 
less, dependent on the irritation which it produces. It is stimulant in 
its effects on the circulation, and promotes the cutaneous and bronchial 
secretions. It is diuretic, by reason of the local irritant action of the 
principles which are eliminated by the kidneys. 

Apiol has decided properties, and in its action strongly resembles 
quinine. It produces headache, tinnitus aurium, vertigo, intoxication, 
etc. 

Petroselinum is rarely employed for its diuretic effects. Its use is 
indicated in dropsy under the same conditions as juniper, squill, and 
other stimulating diuretics. It may be given in the form of infusion 
( 1 ]" — Oj)> one to three ounces at each dose. 

Apiol is a remedy of considerable value in the treatment of mala- 
rial diseases, but it is inferior in every respect to quinine. Its use is 
only justifiable in the treatment of inter mittents, and when the preju- 
dices or idiosyncrasies of the patient forbid the use of quinine. Fif- 
teen grains should be administered in one dose, or in divided doses, 
within an hour, in order to procure the maximum effect, and about 
four hours previous to the paroxysm. 

The evidence is conclusive that apiol has decided emmenagogue 
power. It is a stimulant to the uterine system, and therefore is con- 
traindicated in plethora of these organs, and should not be adminis- 
tered as an antiperiodic to pregnant women. It is indicated when a 
state of torpor of the ovaries and uterus exists. The amenorrhcea of 
anaemia, of functional inactivity, is the form of the malady in which 
apiol is serviceable. The condition of the blood should be corrected 
by iron, constipation should be removed by aloetic purgatives, and the 
apiol, in a considerable dose (fifteen grains), should then be adminis- 
tered at the time of the menstrual molimen, or just preceding the time 
when the flow should begin. If the case has been obstinate, a daily 
dose of apiol may be given for a week, or at least for several days be- 
fore the menstrual period. The neuralgic form of dysmenorrhea is 
also benefited by this remedy. Other neuralgia are, it is said, relieved 
by apiol, but the existence of a malarial cause is, no doubt, the ex- 
planation of its curative action in such cases. 

Authorities referred to : 
Delorme, Dr. Gazette des Hopitaux, 1860, p. 511. 
Joret and Homolle. Bulletin General de Therapeutique, vol. xlviii, p. 32. 



UMNO-GENITALS. 737 

Marotti, Dr. Ibid., 1863, p. 295. 

Stille, Dr. A. Therapeutics and Materia Medica, vol. ii, p. 631. 

Polygonum Hydropiperoides. — Water - pepper. This indigenous 
plant is not recognized by the United States Pharmacopoeia. A fluid 
extract prepared according to the general directions of the United 
States Pharmacopoeia may be prescribed in the dose of xti x to 3 j. A 
solid extract is also to be found in the shops — dose, gr. j — gr. v. 

Actions and Uses. — The taste of hydropiper is hot, pungent, and 
acrid. The juice excites inflammation and vesication when applied to 
the external integument. In medicinal doses it causes a sensation of 
warmth in the stomach, and a " peculiar tingling sensation throughout 
the whole system" (Eberle). Unless given in an overdose it does 
not excite vomiting or produce purging. It stimulates the heart and 
arteries, increases the warmth of the surface, and promotes the cuta- 
neous, bronchial, and renal secretions. It stimulates the menstrual 
flow, and is aphrodisiac. 

This indigenous but little known remedy is a very efficient stimu- 
lating diuretic and emmenagogue. The author can confirm the state- 
ment of Eberle, who reports that " with no other remedy or mode of 
treatment has he been so successful as with this," in amenorrhoea. It 
is adapted to cases of amenorrhoea due to functional inactivity or tor- 
por of the uterine system, and is contraindicated when a condition 
of plethora or congestion exists. The administration of this remedy 
should be begun about a week before the menses ought to appear. 
Thirty minims of the fluid extract should be administered four times 
a day. If anaemia exist, iron should be given ; if constipation, aloes. 

Hydropiper is a remedy of considerable power in functional impo- 
tence. When the erections are feeble, the seminal fluid watery, and the 
testes soft, good results will be obtained from the use of this remedy, 
provided no structural alterations hinder or prevent improvement. 

When hydropiper is administered in these disorders of the sexual 
system, it causes a feeling of weight and tension, and dragging of 
the pelvic viscera. As it tends to increase the blood-supply to these 
organs, it is inadmissible when a state of congestion or inflammation 
exists. 

Authorities referred to : 

Eberle, Dr. John. A Treatise of the Materia Medica and TJierapeutics, fourth edi- 
tion, vol. i, p. 441. 

Porcher, Dr. F. Peyre. Resources of the Southern Fields and Forests, p. 409. 

Ruta. — Rue. The leaves of Euta graveolens (Pharm. 70, not official). 

Composition. — The medicinal activity of this plant depends on the 
presence of a volatile oil. Only the fresh leaves should be employed, 
and, as drying impairs the quality of the drug, the oil should be pre 
scribed. 

48 



138 • EVACUANTS. 

Oleum Rutce. — Oil of rue. This is a volatile oil, of a greenish- 
yellow color, very disagreeable and characteristic odor, and pungent, 
acrid taste. Dose, tu j — ttl v. 

Actions and Uses. — In its local action rue is an irritant ; applied 
to the skin, the oil causes heat, inflammation, and vesication. In ordi- 
nary medicinal doses a sensation of warmth follows its introduction 
into the stomach, and increased action of the heart arid arterial system 
and a subjective feeling of peripheral heat are subsequently produced. 
The cutaneous, bronchial, and urinary excretions become more abun- 
dant, and the odor of the volatile oil is apparent in the breath, the sweat, 
and the urine. In toxic doses the oil of rue produces violent gastro- 
enteritis, prostration, convulsive muscular movements, hebetude of 
mind, etc., strangury and suppression of urine. In women the use of 
rue increases the menstrual flow, and large doses may cause abortion 
to take place. In men this agent promotes the sexual appetite, and 
increases the vigor of the erections. 

A tincture of the oil of rue is an efficient carminative and antispas- 
modic remedy in the flatulent colic and hysteria of women. Almost 
the only use of rue at present is in the treatment of amenorrhcca. It 
is one of the most efficient emmenagogues. Plethora, congestioD, or 
inflammation of the pelvic viscera, contraindicate its use. Functional 
inactivity of the ovaries and uterus is the condition which justifies the 
employment of rue. It has been recommended in menorrhagia when 
the vascular tonus is low, and in uterine haemorrhage after miscar- 
riage. It need hardly be remarked that the condition of pregnancy 
forbids the use of rue. 

Sabina. — Savine. The tops of Juniperus sabina Linne (Nat. Ord. 
Coniferoe). Sabine, Fr. ; Sabenkraut, Ger. 

Composition. — Savine contains an essential oil, in the proportion 
of two to two and a half per cent in the tops and about ten per cent 
in the berries. The oil of savine is isomeric with the oil of turpentine. 

Oleum Sabinrn. — Oil of savine. Dose, m j — Tq, v. 

Extractum Sabinrn Fluidum. — Fluid extract of savine. Dose, v[ v 

TTl XV, 

Actions and Uses. — Savine has a strong, disagreeable odor, and a 
pungent, acrid taste. Applied to the skin, the oil causes inflammation 
and vesication, if the contact be sufficiently prolonged. Introduced 
into the stomach in a full medicinal dose, a sensation of heat, eructa- 
tions tasting of the oil, flatulence, and nausea, are produced. A toxic 
dose sets up a violent gastro-enteritis. The oil diffuses readily into 
the blood, and is excreted by various channels — the breath, the sweat, 
and the urine smelling strongly of it. Increased action of the heart 
and a rise of tension of the arterial system, followed by diminished 
tonus of the vessels, result from its administration in full medicinal 



URINO-GENITALS. 739 

doses. The cutaneous, bronchial, and urinary excretions are rendered 
more abundant by savine. Strangury and bloody urine are caused by 
it in overdoses. The evidence is conclusive that savine exerts a pow- 
erful influence on the uterine system. It increases the menstrual flux, 
and in toxic doses may originate uterine action and cause abortion. 
The abortifacient effect can not be obtained unless by the administra- 
tion of a quantity sufficient to endanger life. 

The only use to which savine is now applied is in the treatment of 
amenorrhcea. It is generally conceded that the estimate of its pow- 
ers made by Pereira is not extravagant, namely, that "it is the most 
certain and powerful emmenagogue of the whole materia medica." 
Savine is indicated in amenorrhcea dependent on deficient activity of 
the sexual system, accompanied by general atony. It is inadmissible 
when a tendency to congestion of the pelvic viscera is present, or in a 
condition of general plethora. Cases of dysmenorrhea are benefited 
by savine when the subject is of relaxed habit, the menstrual flow be- 
ing scanty, provided narrowing of the cervical canal is not the cause 
of the painful and difficult menstruation. Menorrhagia, when due to 
an enlarged, relaxed, and passively congested uterus, and haemorrhage 
after abortion, may sometimes be arrested by this agent. 

The most effective preparation of savine is the oil. This may be 
prescribed in gelatin-capsules, in an emulsion, or in pilular form. The 
fluid extract, if made from the fresh tops, is an excellent preparation. 
Combination with other remedies of the same group increases the action 
of savine. $ 01. sabinse, 3 j ; ol. rutae, 3 j ; tinct. polygon, hydropi- 
per, § j ; ol. amygdal. express., mucil. acacise, aquse menth. pip., aa 3 ij. 
M. Sig. : A teaspoonful twice or three times a day as an emmenagogue. 

Authorities referred to : 

Aran, M. Bulletin General de Therapeutique, vol. xxx, p. 61. 

Beau, M. Le Dr. Ibid., vol. xliii, p. 140. 

Flucker and Hanbttry. PharmacograpMa. 

Husemann, Dr. Theodor. Handbuch, zweiter Band, p. 1200. 

Kohler, Dr. Hermann. Handbuch, p. 387. 

Taylor, Dr. A. S. On Poisons, third edition, London, p. 494. 

Van de Warker, Dr. Ely. The Detection of Criminal Abortion, 1872. 

Cantharis — Cantharides. Cantharis vesicatoria. Cantharide, Fr. ; 
Spanische Fliegen, Ger. 

Tinctura Cantharidis. — Tincture of cantharides. Dose, v\, ij — r\ xv. 

(The other preparations of cantharides, which are used externally 
only, will be taken up in Part III of this work.) 

Composition. — The principal constituent of cantharides is a neu- 
tral, crystallizable principle, ca?itharidin. It contains also an oil, fatty 
matter, and an odorous material. 

Antagonists and Incompatibles. — There is no chemical or physio- 



740 EVACUANTS. 

logical antagonist to cantharides. Poisoning by this substance should, 
therefore, be treated on general principles. The stomach should be 
evacuated by emetics or the stomach-pump ; mucilaginous substances 
should be freely administered ; the gastro-enteritis should be treated 
by opium, etc. 

Synergists. — Oils and fats increase the solubility and favor the 
absorption of cantharidin. The physiological actions of this agent are 
promoted by the other members of this group. 

Physiological Actions. — The odor of cantharides is nauseating, 
fetid, and peculiar. In contact for a sufficient time with the skin or 
mucous membrane, it excites considerable burning, inflammation, and 
vesication. In the stomach it causes a sensation of heat, severe gas- 
tralgia, nausea, and vomiting. Notwithstanding the insolubility of 
cantharidin, it readily diffuses into the blood. It is actively stimulating 
to the circulatory system, and a rise of temperature, with thirst, follows 
in an hour or two. Under these circumstances, the urine becomes 
scanty and burns the passages ; severe pain is experienced in the back 
and loins ; priapism occurs ; and the urine, voided with great difficulty, 
frequently contains albumen and blood. To this excitement of the 
circulatory system and of the genital organs succeeds a condition of 
depression, in which the pulse falls, the arterial tension is lowered, 
and the temperature declines (Radecki). 

When a toxic dose is swallowed, in a short time a sense of constric- 
tion of the oesophagus, with difficulty of swallowing, and ptyalism, 
occur. Intense gastric pain, vomiting of glairy mucus streaked with 
blood, intestinal pain, abdominal tenderness, tenesmus, and mucous 
and bloody stools, are produced. Violent irritation of the genito-uri- 
nary organs is also experienced, manifested by lumbar pain, strangury 
and bloody urine, priapism, swelling and inflammation of the external 
genitals. In most cases of poisoning by cantharides, cerebral effects, 
consisting of muscular trembling, partial or general convulsions, coma, 
and insensibility are produced. Abortion has been caused by toxic doses 
of cantharides, and after death violent metro-peritonitis, gastro-enteri- 
tis, and general peritonitis, have been observed. It is questionable 
whether abortion can be caused by a dose less than toxic. 

Cantharides has frequently caused dangerous symptoms, when used 
with a view to induce venereal excitement. That it does promote the 
sexual appetite is probably true, but this result is accomplished only by 
the use of a quantity sufficient to cause vascular turgescence of the 
sexual organs. 

Therapy. — In acute desquamative nephritis, after the subsidence 
of the acuter symptoms, good results are obtained from cantharides. 
The local condition in which this remedy is serviceable consists in 
hyperemia with loss of vascular tonus. Chronic pyelitis and chronic 
catarrh of the bladder are occasionally remarkably benefited by the 



URINO-GENITALS. 741 

long-continued use of small doses of cantharides. Irritability of the 
bladder, more especially as it occurs in women, without the existence 
of acute inflammation, and not produced by uterine displacements, is 
sometimes quickly and entirely relieved by this remedy. The irritable 
state of the bladder and the vesical tenesmus, which accompany chronic 
prostatic disease, are also sometimes surprisingly relieved by canthari- 
des, but the author is unable to indicate the special circumstances to 
which it is adapted. 

Gleet and prostorrhoea are benefited by cantharides when these 
maladies occur in subjects of a relaxed fiber, with feeble circulation. 
Ringer makes the extraordinary statement that one drop of the tincture 
given three times a day will prevent chordee. 

When spermatorrhoea actually exists, and is due to deficient tone of 
the seminal vesicles, the erections being feeble, and the sexual feeling 
torpid, good results are obtained by the use of cantharides. In cases 
of scanty menstruation, occurring in womeu of lax fiber, with cold 
hands and feet, improvement follows the use of this remedy. It some- 
times happens that monorrhagia is due to relaxed vessels and a general 
lowering of the vascular tonus : under such circumstances cantharides 
may render important service. In these disorders of the sexual system, 
characterized by deficient power, the good effects of cantharides are 
promoted by the use of iron. The tincture of cantharides is the most 
eligible preparation for internal administration. In chronic affections 
of the genito-urinary passages the dose will range from five to fifteen 
drops, rarely the latter, three times a day. 

Authorities referred to : 

Casper's Practisches Handbuch der gerichtlichen Median, by Liman, zweiter Band, 
p. 5*76. 

Husemann, Dr. Theod. Handbuch, zweiter Band, p. 538, et seq. 

Radecki, Fr. Die Cantharidinvergiftung. Inaug. Diss. Schmidt's Jahrbucher, vol 
cxxxviii, p. IV. 

Ringer, Dr. Sydney. Handbook of Therapeutics. 

Taylor, Dr. A. S. On Poisons, fourth edition, London, p. 524 



PAET III. 
II. TOPICAL REMEDIES. 



COUNTER-IRRITATION. 

The Theory of Counter-Irritation. — The application of counter- 
irritation as an expedient of therapeutics has never failed of appre- 
ciation, how vague soever have been the notions as to its mode of 
action, and how much these notions have varied from age to age. 
Before physiology had obtained the data on which a proper theory 
could be founded, the dogma of some master was submissively ac- 
cepted by his followers, until a more specious theory was brought 
forward to displace it. 

When the work of Magendie, the pioneer, and of Bichat, the in- 
terpreter and clinician, laid the foundations of physiological thera- 
peutics, a true conception of the methodus medendi was dimly fore- 
shadowed. Then the relation of the nervous centers to certain dis- 
orders of nutrition — e. g., the myopathies of spinal origin — and 
the alteratious of the structure of nerve-centers induced by patho- 
logical states of the peripheral nerves, became established facts, and, 
in consequence, the influence of counter-irritation began to be ration- 
ally interpreted. Already the doctrine of reflexes had been universally 
established, and now the condition of the vessels as regulated by a 
system of dilator and constrictor organic muscular fibers, which are 
influenced by sensory impressions at distant points, has become a well- 
recognized fact of physiology. These data given, the principles of 
counter-irritation are no longer obscure, and no dogma is needed to 
give them concrete expression. 

When the skin is irritated, by a mustard-plaster, for example, the 
superficial vessels of the part dilate, and an increased amount of blood 
is present in them. For a short distance around the part irritated, 
also, more or less dilatation of the vessels takes place. In this way a 
small amount of blood may be temporarily imprisoned. The influ- 
ence which the retention in an external part of so small an amount of 
blood has on the general circulation, must be very slight. The obvi- 



COUNTER-IRRITATION. 743 

ous relief often afforded by a mustard-plaster can hardly, therefore, be 
ascribed to this limited withdrawal of blood. 

An irritation established in the neighborhood of a part in which a 
morbid action is proceeding may, by reason of the contiguity of the 
tissues, affect the vascular supply to the diseased textures. Ubi irri- 
tatWy ibi fluxus ; but, in order that the fluxion shall modify diseased 
action, it is necessary that there be a continuity of the vascular con- 
nections. The method of Furneux Jordan, which consists in the appli- 
cation of the counter-irritant to the neighboring vascular area, is based 
on this principle. 

An irritation which consists in a local fluxion, and a state of altered 
sensibility in the nerves of the part, may affect the functions of distant 
organs. Counter-irritation applied to a considerable surface increases 
the action of the heart, raises the temperature of the body, and exalts 
the irritability of the nervous system. These are the general or sys- 
temic effects. Distinctly localized results are also produced. When 
one hand is immersed in cold water, a positive fall of temperature takes 
place in the other. Irritation of the lumbar region, as Brown-Sequard 
has shown, is followed by contraction of the vessels of the kidneys. 
Extensive injury to the surface of the body, by burning or scalding, 
may excite ulcerative action in the duodenum, or may set up a pneumo- 
nia. Injury to a motor-nerve trunk may be followed by ascending neu- 
ritis and serious atrophic changes in the multipolar ganglion-cells of 
the anterior columns. It follows from these facts that an irritation of 
the surface which involves the end-organs of the nervous system will 
affect the caliber of the arterioles and modify the functions of the 
trophic nerves. In these results we find a rational explanation of the 
methodus medendi of counter-irritation. 

Certain other physiological laws deserve attentive consideration in 
this connection. An irritation which first produces a tetanic state of 
the vaso-motor nervous system may, if too long continued, exhaust the 
irritability of the organic muscular fiber, and cause paresis. Moderate 
irritation will exalt the functional power of the trophic centers ; but 
excessive and long-continued injury to the surface may set up atrophic 
changes, of which there are numerous examples. In these physiologi- 
cal facts also we find a rational explanation of the injury not unfre- 
quently done by too powerful or too protracted counter-irritation. 

Vesicants, in addition to the effects of counter-irritants sketched 
above, cause an exudation of serum. This exudation may have a two- 
fold effect : 1. To lessen the gross amount of the blood-serum, and 
thus diminish the blood-pressure ; and, 2. To remove toxic or patho- 
logical materials from the tissues and fluids of the inflamed part. More 
powerful systemic effects are produced, and vaso-motor paresis and 
trophic changes are more quickly induced, by blisters than by rubefa- 
cients. 



744 TOPICAL REMEDIES. 



FORMS OF COUNTER-IRRITANTS. 

The remedies employed for the purpose of external irritation are 
divisible into two groups. 

1. Rubefacients ; 

2. Epispastics. 

A rubefacient is a remedy which causes heat and redness ; but, if 
the contact with the skin be sufficiently prolonged, vesication may be 
produced. An epispastic is a remedy which excites inflammation and 
vesication. The first group of remedies are restricted in their applica- 
tion to such therapeutical results as can be attained by a superficial and 
temporary action in the skin. The second group are intended for 
more permanent action and a deeper impression on internal organs. 
These remedies differ not only in the degree, but in the character of 
the effects produced. An impression on the periphery induces some 
kind of molecular modification at the center. According as the im- 
pression is slight or severe are the centric modifications localized to 
the point of reception or transferred to distant points (reflex impres- 
sions). According to the severity of the peripheral impression are 
the resulting local centric disturbance and the reflex changes (trophic 
alterations). Thus a slight peripheral rubefaction may cause a trivial 
centric vascular spasm, but an extensive burn on the body may induce 
vaso-motor paresis, and consequent inflammatory changes in remote 
organs. 

RUBEFACIENTS. 

Sinapis Alba. — White mustard. The seed of Shiapis alba Linne 
(Nat. Ord. Cruciferas). 

Sinapis Nigra. — Black mustard. The seed of Sinapis nigra. 

Charta Sinapis. — Mustard-paper. 

Composition. — When water is added to pulverized black mustard, 
pungent, irritating fumes are given off. These fumes consist of the 
volatile oil of mustard (allyl sulphocyanide). This volatile oil is pro- 
duced by a reaction between certain constituents of the seeds — sini- 
grin (myronate of potassium) and myrosin — in presence of water, and 
at a temperature below 100° Fahr. The boiling-temperature destroys 
the ferment, myrosin, and hence prevents the formation of the volatile 
oil. Mustard contains also a bland fixed oil, which may be procured 
by expression. 

White mustard contains an indifferent, crystalline substance, sinal- 
bin, and myrosin. Sulphocyanate of acrinyl, a product of the reac- 
tion between sinalbin and myrosin, is the rubefacient principle of white 
mustard (Fliickiger and Hanbury). White mustard contains also an 
alkaloid — sinapine. The chemical composition of the two kinds of 
mustard is, it will be seen, closely analogous. Myrosin exists in white 



EMPL ASTRA.— LIN IMENTA. 745 

mustard in larger proportion than in black, hence a considerably larger 
quantity of the volatile oil of mustard is formed when an addition of 
white mustard is made to the black. 

A great variety of plasters and liniments (some referred to already 
in their appropriate connections) are employed to induce a rubefacient 
action. 

EMPLASTRA. 

Emplastrum Capsici. — Capsicum plaster (a resin plaster on which 
is spread a thin layer of oleo-resin of capsicum). 

Emplastrum JResince. — Resin plaster (resin, lead plaster, and yellow 
wax). 

Emplastrum Saponis. — Soap plaster (soap, 10 parts ; lead plaster, 
90 parts). 

Emplastrum Arnicce. — Plaster of arnica (extract of arnica, resin 
plaster). 

Emplastrum Picis Purgundicce. — Burgundy-pitch plaster (Bur- 
gundy pitch, 90 parts ; yellow wax, 10 parts). 

Emplastrum Picis Canadensis. — Canada-pitch plaster (Canada 
pitch, 90 parts ; yellow wax, 10 parts). 

Emplastrum Picis cum Cantharide.— Plaster of pitch with can- 
tharides (Burgundy pitch, 92 parts ; cerate of cantharides, 8 parts). 

LINIMEtfTA. 

Linimentum Calcis. — Lime liniment (equal parts of lime solution 
and cotton-seed oil). 

Linimentum Cantharidis. — Cantharides liniment (cantharides, 15 
parts ; turpentine, q. s. to make 100 parts). 

Linimentum Sinapis Compositum. — Compound mustard liniment 
(volatile oil of mustard, extract of mezereum, camphor, castor-oil, and 
alcohol). 

Linimentum Ammonice. — Liniment of ammonia (water of ammonia, 
30 parts ; cotton-seed oil, 70 parts). 

Linimentum Camphor w. — Liniment of camphor (camphor, 20 
parts ; cotton-seed oil, 80 parts). 

Linimentum Saponis. — Soap liniment (soap, 10 parts ; camphor, 5 
parts ; oil of rosemary, 1 part ; water, q. s. ; alcohol, 70 parts). 

Linimentum Terebinthinw. — Liniment of turpentine (resin-cerate, 
65 parts ; oil of turpentine, 35 parts). 

An excellent rubefacient for long-continued use and moderate ac- 
tivity is the domestic spice-bag. This consists of a mixture in equal 
parts of cloves, cinnamon, allspice, ginger, and a half pint of capsicum, 
sewed into a flat bag. When required for use, it is dipped in vinegar 
or whisky, and laid over the affected region, usually the abdomen. A 
piece of flannel or spongio-piline may be moistened with the tincture 
of these aromatics, and applied for the same purposes. 



?46 TOPICAL REMEDIES. 

A turpentine-stupe, which is one of the most frequently-used ex- 
temporaneous counter-irritants, is made as follows : A piece of flannel 
folded in several layers, or a piece of spongio-piline, is wrung out in 
hot water, and a few drops (five to fifteen) of turpentine are sprinkled 
over it. This is placed over the affected region, and is confined hy a 
towel or napkin pinned around the part. Turpentine, applied in this 
way, is a very active rubefacient, and may even vesicate, so that atten- 
tion is required to avoid overaction. 

EPISPASTICS. 

Ceratum Cantharidis. — Cantharides or blistering cerate. 

Ceratum JExtracti Cantharidis. — Cerate of extract of cantharides. 

Charta Cantharidis. — Cantharides-paper. 

Collodium cum Cantharide. — Collodion with cantharides. 

Jjinimentmn Cantharidis. — Liniment of cantharides. 

Firing. — By the method of firing, merely rubefacient or vesicating 
effects are produced. Firing is accomplished by the application of an 
iron disk provided with a suitable handle (Mayer's hammer). It is 
dipped into boiling water, and then passed, more or less rapidly, over 
the skin of the part to be acted on. Very brief contact suffices to 
vesicate, and this is the usual effect of the application. 

Of the above preparations the most efficient is the ceratum extracti 
cantharidis, the most elegant the charta cantharidis, and the most 
convenient the collodium cum cantharide. The cerates should be 
spread on adhesive plaster, leaving a margin of the plaster to secure 
adhesion to the skin. Before the application of a blister, if prompt 
action is necessary, a mustard-plaster should be laid on long enough to 
produce rubefaction, or the skin should be rubbed with turpentine. 
When the skin is very thin and sensitive, the blister should be covered 
with tissue-paper. When the vesication is to be permitted to heal in 
a short time, or when young and irritable subjects are to be blistered, 
the cantharides-plaster should be removed when distinct redness of the 
skin is produced, and a poultice applied, which will develop the vesi- 
cles. The length of time required for a blister " to draw " is influ- 
enced by the age of the subject and the condition of the skin. From 
two to twelve hours, as a rule, will elapse before vesicles appear ; and, 
when a very deep impression is intended, the blister may remain even 
twenty-four hours. In infants and in certain states of the constitution 
(scorbutus, purpura, scarlatina, etc.), prolonged contact of a canthari- 
des-plaster may cause deep sloughing and very severe nervous symp- 
toms, and adynamia. 

When the vesicles are fully developed, they should be punctured at 
the most dependent point, and the serum, as it escapes, absorbed by a 
soft cloth. If the blistered surface is to be allowed to heal, a dressing 
of raw cotton suffices. If discharge is to be encouraged, resin-cerate 






EPISPASTICS. 747 

or savine-cerate may be applied, spread on a cloth perforated to permit 
the discharge to exude, and covered with raw cotton to absorb the 
fluid. If the blister is slow to heal, boracic-acid lotion is an efficient 
application, or a weak lead-lotion may be used. 

Therapy. — Various methods of counter-irritation are employed in 
the treatment of diseases of the abdominal viscera. For the relief of 
nausea, vomiting, diarrhoea, colic, cholera-morbus, etc., no expedient is 
more generally useful than a mustard-plaster. In persistent vomiting, 
a small blister applied to the epigastrium will often afford permanent 
relief. The good effects of a blister in such cases are enhanced by 
dusting over the exposed derma some powdered morphine. In acute 
inflammatory affections — typhlitis, peritonitis, puerperal peritonitis, 
pelvic cellulitis, etc. — the best results are obtained by the use of tur- 
pentine-stupes during the acute stage, and the application of blisters 
after the acuter symptoms have subsided. The prolonged contact of 
blisters with the abdominal wall of thin subjects has set up peritonitis 
by contiguity of structures. The author has observed instances of 
this kind, and analogous cases have been reported. 

In chest-diseases — pleuritis, pneumonia, pericarditis, etc. — some 
form of counter-irritation is invariably employed, and is often greatly 
abused. At the onset of these maladies a large mustard-plaster to the 
chest, allowed merely to redden the skin, is an excellent expedient ; 
during the progress of the inflammation the turpentine-stupe is gener- 
ally the best application ; to assist in the process of resolution and re- 
pair, the more permanent action of a blister will be serviceable. Much 
has been said about the " blistering-point " in pneumonia. The discus- 
sion is resolvable into this : during the inflammatory stage, blisters are 
harmful, because they stimulate the nervous and vascular systems, and 
are useful when the crisis occurs, to assist in the liquefaction and ab- 
sorption of inflammation products. At the very inception of an acute 
thoracic disease a flying blister may render the same service as a mus- 
tard-plaster, but it possesses no advantage over the latter. A succes- 
sion of " flying blisters " appears to be useful in hydrothorax, to pro- 
mote absorption. 

Counter-irritants are much abused in the treatment of phthisis at 
its various stages. The chest-pains which accompany this disease can 
usually be relieved by mustard and belladonna plasters. Intercurrent 
attacks of pleuritis and pneumonia may be treated by the milder forms 
of irritation. The pustulation of the chest with croton-oil or tartar- 
emetic ointment is rarely if ever justifiable, and deep blistering is al- 
ways harmful. 

In acute inflammation of the meninges, cerehral or spinal, blisters 
are often employed, but there is singularly little proof of their utility. 
When used, they should be confined to the mastoid processes or to 
the nape of the neck. Under no circumstances is it ever justifiable to 



748 TOPICAL REMEDIES. 

share and blister the scalp, as was formerly not unfrequently done in 
various forms of cerebral disease. An aura proceeding from an ex- 
tremity may be intercepted, and attacks of epilepsy averted, by encir- 
cling the limb with a strip of blistering-plaster. Various instances of 
the success of such a blister have been reported. Hysterical paraly- 
sis is most successfully treated by encircling the affected extremity 
with narrow blisters (Reynolds), and hysterical aphonia may some- 
times be very quickly cured by a blister to the larynx. The curative 
effect of such an application is doubtless due to the moral impression 
of the counter-irritant. Blisters over the course of the affected nerve 
are of great service in neuritis. The good effect of the blisters is in- 
creased by treating the blistered surface with morphine. There can be 
no doubt of the curative value of blisters in neuralgia. According to 
Anstie, it is not the mental impression produced by the pain of the 
blister, and not the withdrawal of serum from the focus of pain, which 
explain their efficacy, but they act " as true stimulants of nerve-func- 
tion." The best point at which to apply the blister is " as close as may 
be to the intervertebral foramen from which the painful nerve issues." 
Flying blisters are to be preferred, and, as a rule, exudation of serum 
is not to be encouraged. 

Lumbago, myalgia, and fugitive but recurring muscular pains, are 
sometimes relieved by the warming plasters given at the head of this 
article, or by frictions with ammonia-liniment, turpentine-liniment, etc. 

Blisters are, as a rule, inadmissible in acute affections of the kid- 
neys and bladder. A succession of blisters to the perinaeum is unques- 
tionably serviceable in chronic prostatitis and in gleet. 

Inflammatory affections of the eye and ear are, as a rule, benefited 
by the application of blisters in the neighborhood of these organs. 

The application of blisters is an effective method of treating acute 
rheumatism. According to the plan of Davies and Dechilly, the 
affected joints are enveloped in blisters, which are allowed to remain 
until thorough vesication is produced and serum is abundantly dis- 
charged. The author, who has had considerable experience in the 
treatment of rheumatism by this method, finds that a number of small 
blisters applied around the joint are as effective and less painful. The 
good effects of the blister-treatment are these : the pain and swelling 
are abated, the danger of cardiac complication lessened, and the dura- 
tion of the disease shortened. It is a singular fact that the urine be- 
comes neutral or alkaline under the action of blisters. The curative 
effect of blisters is not, probably, to be ascribed to the withdrawal of 
acid serum from the affected joints, but rather to an influence exerted 
through the trophic nerves on the metamorphosis of tissue. 

As general stimulants, rubefacients and vesicants are employed to 
arouse the vital processes in a condition of great depression or col- 
lapse from any cause, e. g., cholera, pernicious malarial fever, urcemia, 
narcotic poisoning, etc. 



EPISPASTICS. 749 

Contraindications of Blisters. — The acute stage of an inflam- 
mation ; pregnancy ; scorbutus and purpura ; infancy ; debility ; are 
conditions rendering their use improper and injurious. 

The strangury produced by blisters is lessened by the free use of 
diluent drinks, and is relieved when it occurs by an enema of lauda- 
num or the hypodermatic injection of a minute quantity of morphine. 
A decoction of uva-ursi freely drunk will, it is said, prevent strangury, 
but the effect of this remedy is, probably, not greater than that of an 
ordinary diluent. 

The method of " firing " is sometimes very beneficial in neuralgia, 
spinal irritation, myalgia, etc. The effects can be regulated by the 
temperature of the hammer, and by the duration of the contact with 
the skin, and may vary in severity from the mildest rubefaction to 
vesication, and even destruction of the skin. 

Acupuncture. — Needles about three inches in length, and having 
a red wax, hard-rubber, or metal head, are employed for this purpose. 
They are introduced by a rapid rotary motion. Insulated needles are 
used in the same way for conveying the galvanic current to deeply- 
placed nerves. 

Baunscheidtismus. — This is a form of acupuncture, so named from 
Baunscheidt, its inventor. " The instrument employed consists of a 
heavy disk, about half an inch in diameter, having inserted into it 
about twenty-five sharp needles, each about nine-sixteenths of an inch 
in length. To this disk a strong wire spiral spring (five and a half 
inches in length) is attached, and the other extremity of the spring is 
inserted into an elongated spindle-shaped handle." The spring and 
needles are contained in a cylinder, the handle attached. The follow- 
ing is the mode of using it : the open extremity of the cylinder is 
placed firmly on the skin ; the handle is then drawn up, which com- 
presses the spring ; now, if suddenly loosed, the recoil of the spring 
drives the needles smartly into the skin. The punctures may be rubbed 
with a weak mixture of croton-oil, with cajeput-oil, or other suitable 
counter-irritant. 

Actions and Uses. — These are methods of counter-irritation which 
appear to possess peculiar powers. The theories which have been pro- 
posed to explain their mode of action are far from satisfactory. The 
method of Baunscheidt is that of an ordinary counter-irritant added 
to the effects of acupuncture ; but no explanation has hitherto been 
offered which accounts, in a rational manner, for the curative effects 
of acupuncture in certain maladies. 

In tic- douloureux, sciatica, lumbago, and myalgia, it occasionally 
happens that remarkable and instantaneous relief is obtained by the 
insertion of acupuncture-needles deep enough to reach near the affected 
nerve. 

When the patient is timid, the sensibility of the skin may be dimin- 



750 TOPICAL REMEDIES. 

ished by the application of chloroform for a minute, or of the ether- 
spray or methyl chloride. If rapidly rotated by the finger and thumb, 
the needle will penetrate with little suffering. 

Aquapttnctube. — The method of aquapuncture consists in the in- 
troduction of water subcutaneously, or into the substance of muscles. 
A special instrument has been invented for this purpose, the advan- 
tage of which consists in its being armed with several needles, which 
permit the introduction of the water at various points simultaneously. 
Ordinarily, the hypodermatic syringe will suffice for the performance 
of this little operation, and, if patients object to repeated punctures, 
the sensibility of the skin may be obtunded by ether-spray. 

When water is injected under the skin, more or less pain, accom- 
panied by burning, is produced. A wheal is formed about the site of 
the puncture, and redness of the skin and elevation of the temperature 
at that point follow. It is a remarkable circumstance that aquapunc- 
ture has the power to relieve pain in a superficial nerve. So decided 
is this effect that there are physicians who hold that the curative effect 
of the hypodermatic injection of morphine is due, not to the morphine, 
but to the water ! In order that aquapuncture shall relieve pain, it is 
necessary that the water be injected into the neighborhood of the pain- 
ful nerve. Injection at a remote and indifferent point would certainly 
fail of any effect except that reflex effect which is produced by any 
counter-irritant. Aquapuncture, however, has unquestionable power 
as a counter-irritant. 

The method of aquapuncture has been employed with success, 
which must be regarded as extraordinary, in neuralgia?, facial, sciatic, 
and lum bo-abdominal ; in lumbago, irritability of the bladder, uterine 
colic, gastralgia, etc. The author has produced excellent effects from 
the injection of water into paralyzed and toasting muscles. It promotes 
the nutrition of muscles, and contributes to the regeneration of volun- 
tary power. In the various cases to which this treatment is appli- 
cable, the quantity which should be injected will vary from thirty 
minims to a drachm. When the first injection does not relieve in two 
minutes, another should be practiced. It is insisted upon (Lafitte) that 
the water be injected at the painful points (points douloureux). There 
need be no limit to the number of the injections, if they afford relief ; 
for, of course, no injury will result, unless it be the production of an 
abscess at the site of the injections, which is very rare. 

Authorities referred to : 

Anstie, Dr. F. E. On Neuralgia and the Diseases that resemble it, London and New 
York, 1871, p. 192, et seq. 

Ibidem. The Practitioner. On the Theory of Counter-Irritation, vol. iv, p. 156. 

Bennett, Dr. James Eisdon. Remarks on Counter-Irritation. The Practitioner, voL 
ii, p. 321. 

Davies, Dr. Herbert. TJie Lancet, vol. ii, 1865. 



JEQUIRETY. 751 

Dickinson, Dr. W. H. On the Practice of Counter-Irritation. The Practitioner, vol. 
iii, p. 97. 

Dieulafoy, Dr. Georges. Nouv. Diet, de Med. et de Chirurg. Prat., article Douleur. 

Lafitte, Dr. Leopold. L" 1 Union Medicate, October 5, 18*75. 

Delut, Dr. Ibid. 

Ross, Dr. James. On Counter- Irritation. The Practitioner, vol. iv, p. 73. 

Servajan, Joannes. De VAquapuncture, Paris, 1872, p. 56. 

Jequirety. — Seed of Abrus precatorius of the Natural Order Legu- 
minosoe. 

Description. — The name jequirety is a local designation, used by 
the rude peoples of Brazil to indicate its action in some forms of eye- 
diseases. The seeds — the part employed for topical purpose — are of 
a bright-scarlet color, very hard, ovoid in shape, and have a hilum 
surrounded by a black border. 

There are differences of opinion as to the source of the pathogenic 
local action possessed by jequirety. It contains a bitter principle — 
abrin — a large proportion of vegetable albumin, and a ferment. An 
infusion, prepared at a proper temperature (below 60° C), in a few 
hours is found to contain a vast number of microbes in active de- 
velopment, the albumin of the seeds being a soil peculiarly fitted for 
their sustenance and growth. 

The infusion is the preparation used. The formula proposed by 
De Wecker is the following : 

Thirty-two grains of jequirety are well pulverized and thoroughly 
triturated with two ounces of cold water. The mixture is allowed to 
macerate for twenty-four hours. Two ounces of warm water is then 
added, and the infusion filtered immediately on cooling. With this 
the part to be acted on is washed three times a day. 

De Wecker also proposes a solution somewhat stronger than the 
foregoing : One hundred and fifty grains of the seeds (decorticated) 
are macerated for twenty-four hours in two ounces of cold water, and 
filtered. This, or the infusion given above, is applied to the eyelids 
for fifteen to thirty minutes, and a little is allowed to penetrate through 
the lids to the conjunctiva. The applications are kept up for three 
days, as a rule. This period is the " incubation period " of Sattler. 
As respects the pathogenic activity of the solutions, they differ some- 
what according to their strength, but more according to their age. 
Deneffe, of Brussels, and Sattler (De Wecker's assistant), have de- 
scribed minutely, and, as our observations go, accurately, the process 
of inflammation resulting. 

The application of the infusion to the eyes is free from pain, and 
it is not until the incubation period (three hours) has passed that the 
characteristic inflammation begins. Slowly at first, but then more 
rapidly, an acute, suppurative, and membranous inflammation develops, 
the lids are tumefied, glued together, and the conjunctiva coated with 



752 TOPICAL KEMEDIES. 

a yellowisb- white croupous membrane, which reaches its maximum in 
twenty-four hours, continues at that point for the same period, and 
then slowly subsides, the last trace disappearing in four to six days. 
During the greatest height of the inflammation there is fever, some- 
times as high as 10-4° Fahr. 

The infective activity of a solution of jequirety is the greater the 
longer it is macerated — within suitable limits— and hence, by this 
expedient, solutions can be prepared to be adapted to all the varying 
conditions of disease. The strength most used is from 0*5 to 1 per 
cent. 

A final decision has not been reached as to the constituent setting 
up the peculiar inflammation. Sattler, who discovered the ferment 
action and the formation of microbes, referred the inflammation to the 
pullulation of these organisms. Klein has proved, as he supposes, that 
the microbes do not have this pathogenic power. In turn, abrin has 
been, and has not been, considered the agent. Notwithstanding the 
author disclaims the possession of the technical knowledge and expe- 
rience which alone can ascertain the truth at last, he has the convic- 
tion that the natural history of this factitious morbid process admits 
of no other conclusion than that it is due to the microbes themselves, 
or to some product of their own physiological activity. 

Actions and Uses. — To apply a suggestive term to the action, je- 
quirety sets up a substitutive inflammation to take the place of the 
existing morbid process. To what end ? It is only the papillary 
granulations of the eye that are cured by jequirety. True granula- 
tions — trachoma — remain unchanged after the jequirety inflammation 
has passed. According to DenefFe, it is absolutely useless in the treat- 
ment of pannus. There are, however, ophthalmologists of high char- 
acter who find jequirety very useful in these cases, and who explain 
failures by asserting that sufficient time was not given, and that per- 
severing applications, extending over many months, are necessary in 
obstinate cases (Soloveitchik, Smirnoff, Tangeman, and others). 

Jequirety has been successfully used in the treatment of fungous 
granulation of the external auditory canal. Chronic metritis of a 
severe type has been successfully treated, and skin-diseases, of hy- 
pertrophic character, resisting all other agencies, have been cured 
by painstaking applications. Lupus and epithelioma, especially the 
latter, old ulcers with thickened margins and sluggish in character, 
are quickly changed in condition, and, if curable at all, are disposed 
for healing. 

The author must couple some cautions with these recommendations 
of jequirety. The subcutaneous injection of the microbe-laden in- 
fusion causes such general destructive changes in cold-blooded ani- 
mals, and so much local mischief in mammals, that it should be prac- 
ticed in man with great caution, if at all. 



BLOODLETTING. 753 

Authorities referred to : 

Borde, Dr. L. Bui. Gen. de Thhap. for 1884. 
Cornil et Berlioz, MM. Journal de Therapeutique, 1883, p. 814. 
Deneffe, Dr. Ibid., p. 521, et seq. 

Sattler, Dr., and De "VYecker, Dr. Semaine Medicale in Annuaire de Therap, for 
1884. 

Soloveitchik and Smirnoff, Drs. London Medical Record of March 15, 1886. 

BLOODLETTING. 

Venesection, arteriotomy, cupping, leeching. — The manner of bleed- 
ing, whether by opening a vein or an artery, is a surgical subject, which 
it is not necessary to consider in this work. 

Physiological Actions. — Bloodletting may be employed for a 
systemic or local effect. Bleeding from a vein or an artery, by dimin- 
ishing the whole quantity of the circulating fluid, and by altering its 
quality, affects the functions of every organ, and especially of organs 
the seat of an acute hyperemia. Cupping and leeching, if carried far 
enough, may diminish the general blood-pressure and the proportion of 
the morphotic elements ; but their action is largely local and revulsive. 

The effects of bloodletting on the composition of the blood are 
these : the water is increased and the globules, fibrin, and salts are 
diminished in relative amount ; an artificial anaemia is thus induced. 
The action of the heart becomes more rapid and its force lessened ; 
the arterial tension falls, and the pulse assumes the dicrotic character. 
The functions of organs, especially of the brain and nervous system, 
lose energy. Nausea, vomiting, faintness, syncope, and epileptoid seiz- 
ures occur, when the loss of blood is considerable. Epileptiform con- 
vulsions is a constant phenomenon in animals bled to death (Kussmaul 
and Tenner). 

When the quantity of fluid in the vessels is lessened by bleeding, 
thirst is experienced, and absorption is more rapid ; the sensibility to 
pain is diminished, probably, because the perceptive centers are func- 
tionally inactive ; and the power to evolve force, muscular, digestive, 
nervous, etc., is greatly restricted. Only one function, therefore, is 
rendered more active by bleeding ; all the others are depressed in con- 
sequence of the inadequate supply of nutrient material. 

It is a remarkable fact, perfectly well known to old practitioners, 

and to which Sir James Paget has recently called attention, that the 

ill effects of bleeding, in healthy subjects, are very temporary and 

easily repaired. The blood-globules, which are relatively more affected 

by bleeding than the other constituents, are quickly reproduced, and 

the functions of organs suddenly very much depressed soon recover 

their normal energy. That any permanent injury is done to the 

healthy human system by a moderate bleeding seems, therefore, to be 

highly improbable. 
49 



754 TOPICAL REMEDIES. 

Thekapy. — The limits of this work will not permit the introduc- 
tion of any controversial discussions. The author is to be ranked with 
those who do not employ general bloodletting, but he does not deny 
that it is occasionally useful ; and that, indeed, it may be indispensa- 
ble. A summary of the physical conditions in which venesection may 
be useful or indispensable should not, therefore, be omitted from a 
work on therapeutics. 

The therapeutical effect of a general bloodletting in congestion and 
inflammation is largely mechanical. In acute congestion of the lungs, 
when aeration of the blood is seriously impeded ; when there are ex- 
tensive stasis on the venous side, and ischsemia on the arterial side of 
the systemic circulation, great relief may be afforded by the abstrac- 
tion of from four to sixteen ounces of blood. In the apoplectiform 
variety of acute cerebral congestion, damage to the brain may be pre- 
vented by letting blood. The effect of the bleeding is to diminish the 
intra-cranial pressure, and thus relieve the strain on the cerebral ves- 
sels. In eclampsia, especially of the puerperal variety, accompanied 
with the evidences of cerebral congestion, great relief may be procured 
by the timely abstraction of blood. The quantity of blood to be taken 
will depend in part on the character of the subject and on the amount 
of congestion. 

The mechanical effect of the withdrawal of blood from the systemic 
circulation may be most advantageous in cases of sudden over-disten- 
tion of the right cavities of the heart. 

Pulmonary hemorrhage, when dependent on acute congestion of 
the lungs, the general condition being one of plethora, may be promptly 
arrested by opening a vein in the arm. 

The pain of acute pleuritis, and acute peritonitis, can be quickly 
relieved by bloodletting. 

Although it is undeniable that the important results above men- 
tioned may be obtained from general bleeding, it is equally certain that 
as good results in most of the conditions maybe had by other methods. 
Acute diseases make such serious demands on the vital resources of pa- 
tients, that the practitioner should seriously ponder the propriety of 
taking blood even in those cases to the relief of which it may seem to 
be adapted. Large bleedings, experience has abundantly shown, ren- 
der the convalescence from acute diseases tedious — for the patient 
has to make up the losses by venesection as well as the ravages of the 
disease. 

Bleeding by Cups and Leeches. — A large number of cups and 
leeches may produce the systemic effects of a general bleeding. But, 
as a rule, these applications are intended to withdraw blood from the 
affected part, and thus act in the manner entitled revulsive. The local 
irritation caused by cups and leeches must, through the agency of the 
nervous system, affect distant parts in the same manner as other coun- 
ter-irritants. 



BLOODLETTING. 755 

Leeches are preferable to cups when the parts are very sensitive or 
inaccessible. The quantity of blood drawn can be more accurately 
measured when cups are used. The counter-irritant effects are much 
more pronounced from cups than from leeches. 

The amount of blood drawn by a leech will depend on its size, and 
the subsequent loss of blood, when the bleeding is encouraged, is de- 
termined by the vascularity of the part. As a general rule it may be 
stated that a leech will draw about four times its own weight — about 
one to two drachms. To obtain from any given patient four ounces 
of blood, one ounce of leeches must be applied. 

In acute gastric, enteric, and peritoneal inflammations, if the patient 
be plethoric, and there is decided sthenic reaction, leeches to the abdo- 
men are very serviceable. The number to be applied will always de- 
pend on the effect to be produced, employing the rules given above as 
the basis of the estimate. In typhlitis and perityphlitis, the author 
has seen such good results produced by leeches, that he holds they 
should never be omitted when the tenderness and fever begin. In 
acute hepatitis and congestion of the liver, and in acute dysentery, the 
best results are obtained by the application of leeches to the margin of 
the anus. Haemorrhoids that are swollen, painful, and irreducible 
without great suffering, are much relieved by the application of leeches 
directly to them. Pruritus of the anus, when due to engorgement of 
the portal circulation, and accompanied by heat of the anal region, 
may sometimes be cured by leeching the parts affected. 

Acute desquamative nephritis, pyelitis, and congestion of the kid- 
neys, are ameliorated by the application of cups to the lumbar region. 

The following acute affections of the respiratory organs, when they 
occur in robust persons, and are accompanied by sthenic reaction, are 
favorably influenced in their course and duration by the application of 
cups or leeches — usually the former : pleuritis, pericarditis, acute ton- 
sillitis, acute laryngitis, and i?iflammatory croup. 

In acute inflammations of the uterus and its appendages, decisively 
good results are obtained by the application of leeches to the hypogas- 
tric region, to the iliac fossae, or to the uterus. 

Cupping the nape of the neck, or leeches to the mastoid process, are 
probably of service in acute congestion or inflammation of the intra- 
cranial structures ; but the indiscriminate employment of bloodletting 
in any case of cerebral disease is to be condemned. The correct rule 
may be formulated as follows : When bloodletting is indicated in in- 
tracranial maladies, venesection or arteriotomy (temporal artery) is to 
be preferred to the use of cups or leeches. 

Although good results are obtained by the local abstraction of blood 
in the diseases above mentioned, the author must express his convic- 
tion that the chief utility of cupping and leeching consists not in the 
blood withdrawn, but in the derivant and counter-irritant effect which 



756 TOPICAL REMEDIES. 

they produce. Dry cups, a mustard-plaster, a turpentine-stupe, or 
other counter-irritant application, may render the painful process of 
cupping or leeching unnecessary. 

ESCHAROTICS. 

The substances belonging to this group are employed for the pur- 
pose of destroying the tissues to which they are applied. They differ 
in their mode of action, in the extent of the destruction which they 
effect, in their capacity for diffusion into the blood, and in the results 
which they severally accomplish. 

They are prescribed for the purpose of cauterizing poisoned wounds 
— syphilitic ulcers, snake-bites, the bites of rabid animals — for the re- 
moval of gangrenous parts, foul or exuberant granulations, and espe- 
cially for the destruction of malignant growths. When the diseased 
parts, to the destruction of which they are devoted, have been fully 
acted upon, the caustic action is ended ; poultices are applied to favor 
the entire separation of the sloughs, and a healthy surface is finally 
left to heal by granulations. 

The members of this group have, with one exception, been dis- 
cussed elsewhere : 

The mineral acids. 

The chloride and sulphate of zinc. 

Potassa fusa and potassa cum calce. 

Arsenious acid. 

The acid nitrate of mercury. 

Bromine. 

Acidum Chromicum. — Chromic acid. In deep-red, needle-form 
crystals, deliquescent, and very soluble in water, forming an orange- 
red solution. 

Actions and Uses.' — Chromic acid is an oxidizing caustic. When 
the action ceases, sesquioxide of chromium remains. It is slow in ac- 
tion, and not very painful, but it penetrates deeply and is remarkably 
destructive. Small animals, as mice and birds, are dissolved entirely, 
bones and all, by chromic acid. Owing to the fact that it penetrates 
deeply without much pain, care must be used in its application as a 
caustic, lest it injure parts which are not intended to be affected. 
When it is applied as a caustic, the surrounding tissues must be well 
protected. For the destruction of malignant growths, haemorrhoids, 
warts, etc., the acid should be made into a paste by the addition of 
sufficient water. The part to which it is applied first becomes yellow, 
then brownish, and ultimately black, and the eschar is detached in 
from twenty-four to forty-eight hours. 

A solution of chromic acid of the strength of one hundred grains to 
an ounce of distilled water is an efficient local application in syphilitic 



EMOLLIENTS. 757 

loarts and vegetations, condylomata, lupus, sycosis, tinea tonsurans, 
etc. A still stronger solution (grs. xv — 3 j of hot water) has been in- 
jected into the uterine cavity with success in cases of uterine hemor- 
rhage and uterine catarrh (Wooster). 

Authorities referred to : 

Busch, Dr. E. Annuaire de TJierapeutique, vol. xxiv, p. 229. 

Heller, Dr. Ibidem, 1853, p. 283. 

Marshall, John. The Lancet, 1857, vol. i, p. 88. 

Wooster, Dr. The American Journal of the Medical Sciences, 1869, p. 367. 

EMOLLIENTS, DEMULCENTS, AND PROTECTIVE AGENTS. 

Glycerinum. — Glycerin. A colorless, inodorous, sirupy liquid, of a 
sweet taste, and having the specific gravity of 1 '25. It is soluble in 
water and in alcohol, but not in ether. 

Glycerin- Ointment. — (Unofficial.) (Spermaceti, f ss ; white wax, 
3 j ; oil of almonds, | ij ; glycerin, § j — add the glycerin to the 
melted ingredients, and stir briskly till cold.) (Squire.) 

Glyceritum Vitelli. — Glyconin. An emulsion of glycerin and the 
yelk of eggs — 45 parts of the yelks and 55 parts of glycerin. (U. S. P.) 

Glycerin- Cream. — (Glycerin, 1 ; soft soap, 1 ; cherry-laurel water, 
1.) (Squire.) 

Glycerin- Cream with Camphor. — (Glycerin, 2 ; camphor, 1 ; recti- 
fied spirit, 1.) (Squire.) 

Glyceritum Amyli. — Glycerite of starch. (Starch, 10 parts ; gly- 
cerin, 90 parts.) 

Properties. — Exposed to the air, glycerin slowly absorbs moist- 
ure, but it does not evaporate, and it does not become rancid or under- 
go fermentation spontaneously. It is unctuous to the touch, and is 
obstinately sticky. Glycerin possesses remarkable solvent powers. 
One part of iodine and one of iodide of potassium dissolve in two parts 
of glycerin. Bromine, the iodide of sulphur, the chlorides of potas- 
sium and sodium, the alkalies, some of the alkaline earths, many of the 
neutral salts, the vegetable acids, especially tannic, most of the alka- 
loids (morphine, quinine, strychnine, veratrine, and atropine), and car- 
bolic acid, are soluble in glycerin. The fatty acids, cocoa-butter, 
camphor, chloroform, calomel, iodide of lead, and the resins, do not 
dissolve in glycerin. 

The antiseptic property of glycerin is decided. Yaccine lymph 
may be preserved unchanged almost indefinitely when stored up in 
pure glycerin ; and anatomical preparations, and specimens of natural 
history, are kept in preservative solutions consisting chiefly of this 
substance. Microscopical and pathological specimens are after a time 
softened and disintegrated by pure glycerin. 

Applied to the tissues of the body, glycerin, if pure, is perfectly 



758 TOPICAL REMEDIES. 

bland and unirritating, as a rule, but in some subjects severe smarting 
is produced on contact of the purest glycerin with the mucous mem- 
brane. AYhen it contains the fatty acids, oxalic or formic acids, it 
possesses very positive irritant qualities. It abstracts water from the 
tissues. 

Theeapt. — No systemic effects are produced by the stomach ad- 
ministration of glycerin. It is an efficient remedy in acidity, pyrosis, 
and flatulence, in the dose of a drachm, before, with, or after meals. 

Glycerin has been proposed and used as a substitute for cod-liver 
oil, in the various cachectic states in which the latter is prescribed. It 
has been conclusively shown that it is inferior to cod-liver oil in every 
respect. As a vehicle for the administration of cod-liver oil, it is 
extremely serviceable (glyconin, a teaspoonful ; cod-liver oil, a tea- 
spoonful ; tincture of cinnamon, ten drops). 

Good results have been reported from the use of glycerin in dia- 
betes, but the data are as yet insufficient to enable a correct estimate of 
its real value to be made., The internal administration of glycerin 
has been resorted to for the removal of acne with success. It is 
said to destroy intestinal trichina, and may be given freely in trichi- 
nosis. 

The most important applications of glycerin, besides its numerous 
uses as a vehicle, are topical as an emollient. Applied to the affected 
mucous membrane by means of a camel's-hair pencil, pure glycerin 
affords great relief in acute coryza. Chronic follicular pharyngitis, 
accompanied with profuse secretion, is generally improved by the same 
application, but the addition of tannic acid greatly enhances its cura- 
tive power in this affection. A solution of morphine in glycerin, ap- 
plied to the fauces with a brush, relieves the cough of phthisis. A 
better application in many respects is a mixture of glycerin, crystal- 
lized sugar, and whisky. This mixture, allowed to trickle slowly down 
the fauces, allays irritability and keeps the mucous membrane moist 
(glycerin, two parts ; whisky, one part ; crystallized sugar, a suffi- 
ciency). 

An enema of glycerin and infusion of flaxseed (one to four) allays 
the tenesmus in cases of acute dysentery. 

For chapped hands or face, glyconin is an excellent application. 
In seborrhoea, glycerin-cream gives good results. For fissures of the 
nipple, Stille strongly recommends a " liniment made by adding one 
part of tincture of benzoin to six or eight of glycerin, and filtering 
the mixture." 

In pityriasis and in the papular eruptions, glycerin is serviceable, 
but, in general, it may be stated that its use in skin-diseases is disap- 
pointing, and that it is inferior as a local application to the usual oils 
and fats employed in this way. 

Glycerin has been used as a dressing for wounds and ulcerated 



PROTECTIVES. 759 

surfaces, with more or less advantage. It is largely prescribed by 
gynaecologists as a topical application to erosions and ulcerations of 
the cervix uteri, and for the relief of vaginal leucorrhcea. 

The glycerite of starch (plasma) is an excellent vehicle for the ap- 
plication of astringents to the eye, and is much employed by ophthal- 
mologists for this purpose. Glycerin is used by otologists to soften 
cerumen, to entangle insects which have entered the ear, to diminish 
the secretion of pus, and to relieve the morbid state of the auditory 
canal in cases of otorrhcea. 

Collodium. — Collodion. Is a slightly opalescent liquid, of a sirupy 
consistence. By long standing it deposits a layer of fibrous matter, 
and becomes more transparent. This layer should be reincorporated, 
by agitation, before the collodion is used. When applied, it should 
form a colorless, transparent, flexible, and strongly contractile film. 

Collodium Flexile. — Flexible collodion. (Collodion, ninety-two 
parts ; Canada turpentine, five parts ; castor-oil, three parts.) 

Liquor Gutta-Perchse. — Solution of gutta-percha. (Gutta-percha, 
nine parts ; carbonate of lead, ten parts ; commercial chloroform, 
ninety-one parts.) 

Actions and Uses. — These solutions, when applied to the integu- 
ment, evaporate, leaving a transparent film or coating impervious to 
air and moisture. In drying, collodion contracts energetically, and 
may indeed produce such a degree of constriction as to cause pain, 
and to render the part bloodless. Flexible collodion contains turpen- 
tine and castor-oil, which confer the property of flexibility, while they 
do not impair the impermeability of the film. The solution of gutta- 
percha has properties similar to flexible collodion. 

These solutions are employed to protect exposed parts from the 
contact of air, to secure primary union of incised wounds, to cause 
resolution of inflamed parts by mechanical pressure, etc. 

Some cases of chronic tubercular and squamous shin-diseases are 
much improved by coating them with the gutta-percha solution. Pre- 
vious to the application of the solution all scales should be removed. 
Excellent results have been obtained in herpes zoster by a thick coating 
of the flexible collodion or the gutta-percha solution : the pain is re- 
lieved, the vesicles aborted, and the duration of the disease shortened. 
As this is a self -limited disease, there must remain a suspicion of post 
hoc rather than propter hoc. Erysipelas, especially of the traumatic 
variety, is, at least, much relieved as regards the local symptoms by a 
thick coating of flexible collodion, but there is no evidence that it actu- 
ally shortens the duration of the disease. Burns to the first degree 
are greatly benefited by the same application ; it prevents contact of 
the air, and allays the irritation and pain. When, however, there is 



760 TOPICAL REMEDIES. 

much exudation, or sloughing takes place, an impermeable coating 
adds to the distress. 

Collodion has been used without much success in small-pox, to hin- 
der the development of the pustules. Small boils, carbuncles, nwvi, 
and even superficially placed aneurisms, may be so compressed, as to 
arrest the local inflammation or to cause coagulation of the blood. 
Orchitis may be treated by a coating of collodion, instead of strapping. 
When the mechanical effects of the collodion are to be obtained, suc- 
cessive layers must be applied. 

Fissures of the nipples are best treated by flexible collodion or gutta- 
percha solution. The fissures are carefully wiped dry, well approxi- 
mated, and then thoroughly coated. Nipples that are retracted may 
be made more prominent by surrounding them, after being well drawn 
out, with a thick layer of collodion so placed that on contracting it will 
pucker the skin of the areola. 

Collodion has been used with success as a means of compression in 
umbilical hernia, spina-bijida, varicocele, etc. 

Chondrus. — Chondrus crispus. Irish moss. 

Cetraria. — Cetraria Islandica. Iceland moss. 

Decoctum Cetrariw. — Decoction of Iceland moss. 

Composition. — The principal constituent of chondrus is a mucilage, 
which, when dry, is horny, but swells up in water, forming a jelly. 
Cetraria contains about seventy per cent of a starch (lichen-starch), a 
decoction of which gelatinizes on cooling. In addition to this starch 
cetraria contains a bitter principle (cetrarin), and a peculiar acid (lich- 
eno-stearic acid). 

These lichens are used only for the production of diets for the sick. 
They were formerly supposed to possess some peculiar virtues which 
rendered them serviceable to pulmonary invalids. As articles of food, 
they have a very low position as regards nutritive value. The decoc- 
tion of cetraria may be used as a stomachic tonic, containing as it does 
a bitter principle ; but it is only to be prescribed when the more effi- 
cient remedies are not well borne. 

Chondrus may be made into jelly or blanc mange, in the same way 
as gelatin is now prepared for this purpose. Neligan gives the fol- 
lowing recipe for the preparation of a jelly from chondrus : Chondrus, 
washed and macerated, thirty grains ; spring-water, a pint ; boil down 
to one half and strain with expression, and add to the strained liquor 
four ounces of white sugar, one ounce of gum-acacia, and thirty grains 
of powdered orris-root ; heat to dryness with a gentle temperature, 
stirring constantly so as to obtain a pulverulent mass, to which three 
ounces of arrow-root are to be added by trituration. A jelly is pre- 
pared with this powder by rubbing up a teaspoonful of it with a little 
cold water, and then pouring a cupful of boiling water on it. 









DEMULCENTS. 761 

Acacia. — Gum-arabic. A gummy exudation from Acacia vera, and 
other species of Acacia. 

Mucilago Acacice. — Mucilage of gum-arabic. 

Syrupus Acaciw. — Sirup of gum-arabic. (Mucilage of acacia, 25 
parts ; sirup, 75 parts.) 

Tragacantha. — Tragacanth. The gummy exudation from Astraga- 
lus gummifer, and from other species of Astragalus. 
Mucilago Tragacanthm. — Mucilage of tragacanth. 

Sassafras Medulla. — The pith of the stems of Sassafras officinale. 

Mucilago Sassafras Medullce. — Mucilage of sassafras-pith. 

Actions and Uses. — These preparations are used as demulcent 
drinks, in cases of acute inflammation of the stomach and intestines. 
They are supposed to make a protective coating on the inflamed part, 
and thus save it from further injury. They are especially indicated 
when irritating and corrosive substances have been swallowed. They 
are also frequently prescribed as diet-drinks in fevers and in acute in- 
flammations, in accordance with the supposition that they are not only 
soothing to the alimentary canal, but are, in a limited sense, foods. As 
nutrients these gums and mucilaginous substances rank very low, and 
can by no means take the place of such a food as milk. Furthermore, 
they are exceedingly apt to undergo fermentation, and to produce flatu- 
lent colic and diarrhoea. 

Mucilaginous drinks are very frequently taken in catarrhal affec- 
tions of the bronchial tubes and of the kidneys, with the view to mod- 
ify the morbid process going on in these parts. It need hardly be 
stated that such a theory of the utility of demulcents is erroneous. 
Cough is modified by an influence which is probably reflex, when mu- 
cilages are applied to the fauces ; but in no other way can the mucous 
membrane of the air-passages be affected by such remedies taken into 
the stomach. As gums undergo digestion in the alimentary canal, it 
is obvious that they can not act as demulcents on any part of the 
urinary tract. 

The chief use of these remedies is in extemporaneous prescriptions, 
to hold insoluble medicines in suspension, and to cover the taste of dis- 
agreeable ingredients. 

Linum. — Flaxseed. The seed of Linum usitatissimum. 
Lini Farina. — Flaxseed-meal. 

Infusum Lini Compositum. — Compound infusion of flaxseed. 
(Flaxseed, § ss ; licorice-root, 3 ij ; boiling water, Oj.) (Not official.) 

Ulmus. — Slippery-elm bark. The inner bark of Ulmus fulva. 
Mucilago Tllmi. — Mucilage of slippery-elm bark. 



762 TOPICAL REMEDIES. 

Glycyrrhiza. — Licorice-root. The root of Glycyrrhiza glabra. 

Extraction Gtycyrrhizm. — Extract of glycyrrhiza (licorice). 

Extraction Glycyrrhizcv Purum. — Pure extract of glycyrrhiza. 

Extraction Glycyrrhizce Fluidum. — Fluid extract of glycyrrhiza. 

Mistura Glycyrrhizce Composita. — Compound licorice-mixture 
(brown mixture). A simple expectorant containing paregoric, wine of 
antimony, and spirits of nitrous ether. Dose, 3 j — 1 ss. (Not official.) 

Actions and Uses. — The remedies of this group contain mucilagi- 
nous constituents on which their properties depend. They are fre- 
quently prescribed as protectives in gastro-intestinal disorders, and as 
expectorants in bronchial affections. 

Poultices. — Flaxseed-meal, powdered slippery-elm bark, and Indian 
or corn meal, are most frequently used for the preparation of poultices. 
Wheat-bread and milk are also occasionally employed for the same 
purpose. 

In the preparation of a poultice, the meal is slowly incorporated 
with hot water, until a mass of the proper consistency is made. The 
mixture itself should not be applied immediately to the part, for it 
dries and adheres with considerable tenacity. A piece of washed mus- 
lin of quadrangular shape, and of sufficient size, is selected ; the hot 
mass is spread on one end of the muslin, leaving a margin of one inch 
on three sides ; the long end of the muslin is then folded over the 
mass, and the free margins are stitched or pinned together. If the 
poultice is not frequently renewed, to prevent drying, some glycerin 
should be added to the surface which is to remain in contact with the 
tissues. Laudanum, or other narcotics, may be stirred in with the 
meal if the relief of pain be desirable. 

A yeast-poultice consists of brewers' yeast, to which sufficient flax- 
seed is added to give the proper consistence. 

A charcoal-poultice differs from an ordinary poultice in having 
powdered charcoal incorporated with the mass. In order that a char- 
coal-poultice shall have the proper consistence, the mass should be 
thin enough to take up a sufficient quantity of charcoal. 

Actions and Uses. — A poultice is a means of applying continu- 
ous heat with moisture, and of softening the tissues. An afflux of 
blood takes place to the part, the vessels dilate, the tissues, softened 
by the combined influence of heat and moisture, permit the easy diffu- 
sion of the fluids. If the process of inflammation has begun, or is in 
progress, the stasis is relieved, the tension of the inflamed part is less- 
ened, and resolution is thus favored ; or, if the stage of exudation is 
reached, the migration and multiplication of the white corpuscles are 
promoted, and the extrusion of purulent elements facilitated. The 
accumulation of blood in the neighborhood of the poultice seems to 
diminish the pressure elsewhere, and thus poultices of large size lower 



POULTICES. 763 

the arterial tension and lessen stasis in internal parts. Poultices re- 
lieve the pain of inflamed parts by relaxing the tissues, and thus re- 
moving pressure from the sensory nerve-lilaments. The impression 
thus made on the peripheral nerve-endings is transmitted to the center 
and reflected over internal organs. It is within the range of every- 
body's personal experience that warm, moist applications relieve pain 
in internal and distant parts, which have no anatomical connection 
with the integument to which the applications are made. 

Poultices have, therefore, a local and a systemic effect. Their 
therapeutical uses are based on this conception of their physiological 
actions. They are prescribed to relieve the tension and to promote 
resolution or suppuration in boils, carbuncles, and other superficial in- 
flammations, to hasten the healing of irritable ulcers, to favor the sep- 
aration of gangrenous sloughs, etc. Foul-smelling wounds requiring 
the use of poultices are best treated with the yeast or charcoal poul- 
tice. 

Unquestionable benefit is derived from the application of hot 
poultices externally in acute fancied inflammations, in pneumonia- 
pleuritis, pericarditis, hepatitis, peritonitis, etc. 

The application of poultices sometimes degenerates into abuse. If 
too long continued, the skin becomes white, wrinkled, and sodden ; 
small abscesses or boils form, and the vessels of the parts very slowly 
regain their tone. If kept too long in contact with wounds or ulcer- 
ated surfaces, the granulations become pale and flabby, and the heal- 
ing process is retarded. Applied indiscreetly to inflamed joints, they 
may promote suppuration, and thus permanently injure these struc- 
tures. If kept long in contact with a large extent of surface, they 
will lower the general tone and vigor of the system, depress the sys- 
temic circulation, exhaust the irritability of the vaso-motor nerves, 
and thus seriously embarrass the reparative process, if not wholly 
prevent repair. 



INDEX OF EEMEDIES, 



PAGE 

A 

Acacia < 761 

Aceta : 

Acetum Opii 571 

Lobelia? , 639 

Sanguinariae 335 

Scillae 734 

Acetanilide 392 

Acida : 

Acidum Arseniosum 154 

Aceticum . 232 

Benzoicum 389 

Boricum 387 

Carbolicum 348 

Chromicum 756 

Citricum 232 

Gallicum 317 

Hydrobromicum Dilutum 603 

Hydrocyanicum Dilutum , 641 

Lacticum 101 

Hydrochloricum 103 

Mtricuni 104 

Nitromuriaticum 104 

Phosphoricum 104 

Pyrogallicum 325 

Salicylicum 362 

Sulphuricum 103 

Sulpburosum 234 

Tannicum SIT 

Tartaricum 232 

Aconitine 654 

Aconitum "Napellus and its preparations 654 

Acupuncture 749 

Adeps 112 

Benzoinatus 112 

Adonidin 475 

^Ether 542 

Aceticus 543 

Agaricin 669 

Ailanthus 668 

Air 85 

Compressed 88 

Alcohol 521 

Ale 536 

Aliment 28, 66 

Animal 30 

Vegetable 40 

in Inflammation 56 



PAGE 

Aliment in Digestive Disorders 58 

in Cachexia} 59 

Alimentation, Kectal 63 

Alkalies 200 

Alkaline Mineral Springs 216 

Alnus Cerulata 319 

Aloes and its preparations . . . , 698 

Aloin 699 

Alum 313 

Alumen 313, 620 

Alumen Exsiccatum 313 

Ammonia. 223 

Ammoniacum and its preparations 506 

Ammonia} Valerianus 507 

Ammonium and its preparations 223 

Ammonii Benzoas 3S9 

Amygdalae Oleum Expressum 103, 112 

Amyl Nitrite 647 

Amylum Iodatum 241 

Anaesthesia 550 

Local 561 

Anaesthetics 495, 550 

Animal Aliment 30 

Animal Diet 49 

Anemonine 664 

Anthelmintics 712 

Antifebrin 392 

Antimony and its preparations 304 

Antipyrine 381 

Antiseptics 340 

Antiseptic Oils 395 

Apiol 736 

Apomorphine 678 

Aqua 69 

Aqtjm: 

Aqua Acidi Carbolici 349 

Ammonia} 224 

Chlori 344 

Creosoti 349 

Aquapuncture 749 

Arbutin 732 

Argentum and its preparations 281 

Arnicine 619 

Arnica and its preparations 619 

Aromatic Bitters 171 

Arsenic and its preparations 154 

Arterial Transfusion 25 

Artificial Digestion 62 



706 



INDEX OF REMEDIES. 



PAGE 

Asafoetida and its preparations 503 

Aspidium 716 

Aspidosperminc 673 

Atomization of Liquids 9 

Atropine 479 

Auruni and its preparations 279 

B 

Bantingism 46 

Baptisia 706 

Baptisia 706 

Barium 229 

Barii Chloridum 229 

Baths 71 

Baunscheidtismus 749 

Beer 536 

Belladonna and its preparations 479 

Benzoates 389 

Benzoic Acid 389 

Benzoin 389 

Berberina 168, 177 

Berberine 163, 177 

Beverages 66 

Bismuth and its preparations 151 

Bitters, Aromatic 171 

Bitters, Simple 167 

Blisters 746 

Bloodletting 753 

Boracic Acid 387 

Borocitrates 3S3 

Borotartrates 3S9 

Brandy 522 

Bray era and its preparations 717 

Bromine 345 

Beomides : 

Ammonium 593 

Calcium 593 

Lithium 593 

Potassium 594 

Sodium 594 

Broom 732 

Broths, Animal, Formulae for 57 

Brown Mixture 304, 762 

Brucine 431 

Buchu and its preparations 732 

Burgundy Pitch 745 

Buttermilk-Cure 53 

C 

Cacao Butter 112 

Cadmium and its preparations 308 

Caffeine and its preparations " 516 

Cajuputol 895 

Calabar Bean 629 

Calcii Hypophosphis 128 

Calcii Phosphas Praecipitatus 128 

Calcium and its preparations 210 

Calomel 263 

Calumba and its preparations 168 

Calx 210 

Chlorata 844 

Cambogia 706 

Camphor and its preparations 499 

Camphor Monobromate 500 

Cannabis Americana 508 



PAGE 

Cannabis Indica ^ 508 

Cannabinum Tannicum 503 

Canella 171 

Canquoin's Paste 303 

Cantharidal Collodion 746 

Cantharidin 739 

Cantharis and its preparations 739 

Capsicum and its preparations 729 

Carbolic Acid 348 

Carica papaya 98 

Carlsbad 221 

Carophyllus 395 

Carota 733 

Cascara Sagrada 689 

Cascarila , 171 

Castanea vesca 320 

Castor-oil 6S9 

Catechu and its preparations 317 

Cathartics 6S6 

Centaury, American 168 

Ceeata : 

Ceratum Cantharidis 739 

Extracti Cantharidis 746 

Plumbi Subacetatis 293 

Zinci Carbonatis 299 

Cerebral Excitants 499 

Sedatives 521 

Cerium and its preparations 309 

Cetraria- 760 

Cetrarin 760 

Chalk 210 

Chalybeate Mineral Springs 149 

Champagne 531 

Chaet .e : 

Charta Cantharidis 746 

Sinapis 744 

Chenopodium and its preparations 715 

Chimaphila and its preparations 732 

Chinoidine 1S1 

Chinoline 376 

Chloral Hydrate , 564 

Croton 570 

Chlorinated Lime 344 

Chlorine 343 

Chlorodyne 549 

Chloroform 546 

Chondrus 760 

Chromic Acid 756 

Chry sophanic Acid 637 

Cimicifuga and its preparations 476 

Cimicifugine 477 

Cinchona and its preparations 180 

Cinchonidine 1S2 

Cinchonine 1S1 

Citric Acid 232 

Citrine Ointment 264 

Coca 511 

Cocaine 511 

Cocoa 66 

Cocculus 414 

Codeine 572 

Cod-liver Oil 112 

Coffee 66 

Colchicine 827 

Colchicum and its preparations 327 



INDEX OF REMEDIES. 



767 



PAGE 

Collodion 759 

Collodium cam Cantharide 746 

Collodium Flexile 759 

Stypticum 317 

Colocynth and its preparations 702 

CONFECTIONES : 

Confectio Rosae 319 

Senna? 095 

Conine 605 

Conium and its preparations 605 

Convallaria 470 

Convallarin 471 

Copaiba and its preparations 725 

Copper, preparations of 2S9 

in Metallotherapy 312 

Coptis 168 

Cornus Florida 163 

Corrosive Sublimate 263 

Counter-irritants 742 

Creosote 349 

Creta 210 

Croton-Chloral 570 

Croton-oil 707 

Cubeb and its preparations 727 

Cuca 511 

Cupri Sulphas 239, 076 

Cuprum and its preparations 2t>9 

Curara. 610 

Curarine 610 

Cyanide of Potassium 645 

D 

Dandelion 733 

Daturine 491 

Decocta : 

Decoctum Cetrariae T60 

Chimaphilae 732 

Cinchona? Flavae 181 

— Cornus Florida? 16S 

Hsematoxyli 318 

Quercus Alba? 318 

Sarsapariila? Compositum 330 

Uva? Ursa 732 

Demulcents 757 

Denutrition 44 

Diet-Drinks, formula? for 57, 61 

Diet, Dry 47 

Milk 50 

Diet, plans of 44 

Digestion-Ferments 96 

Digitaline 463 

Digitalis and its preparations 462 

Douche 73 

Nasal 7 

Dover's Powder 571 

Dry Diet 47 

Duboisia 497 

Duboisine 497 

E 

Effervescing Powders 209 

Electric Baths 412 

Electro-Magnetism 408 

Elaterin 709 

Elaterium 709 



Electricity 398 

Electrolysis 423 

Electro-Diagnosis 416 

Physiology 412 

Therapy 419 

Emetine 6S0 

Emetics 676 

Emollients 757 

ElIPLASTEA I 

Emplastrum Ammoniaci 506 

Ammoniaci cum Hydrargyro 262, 506 

Antimonii 304 

.Arnicas 745 

Asafoetida 503 

Belladonna? 479 

Ferri 132 

Hydrargyri 263 

Opii 571 

Picis Burgundicae 745 

Picis Canadensis 745 

Picis cum Cantharide 745 

Plumbi 293 

Ems 217 

Endermatic Method 6 

Enemata 710 

Forms of 711 

Nutrient 63 

Enepidermatic Method 5 

Epidermatic Method 6 

Epispastics 746 

Epsom Salts 691 

Ergot and its preparations 443 

Ergotin 443 

Ergotinine 449 

Erigeron 731 

Erythroxylon 511 

Escharotics 756 

Eserine 630 

Ether 542 

Ether Aceticus 543 

Ethyl Bromide '. 543, 559 

Iodide. 253 

Eucalyptol , 174 

Eucalyptus and its preparations 1 74 

Euonymin 705 

Euonymus 705 

Evacuants 676 

Exteacta : 

Extractum Aconiti 654 

■ Belladonnae 479 

Belladonna? Alcoholicum 479 

Cannabis Indicae 503 

Cinchonae 1S1 

Colocynthidis 702 

Colocynthidis Compositum 702 

Conii Alcoholicum 605 

Convallarii. 471 

Digitalis 462 

Duboisiae 497 

Eucalypti 174 

Gentianae 1 67 

G-lycyrrhiza? 762 

Haematoxyli 31 8 

Hyoscyami Alcoholicum 492 

Krameria? 318 



'68 



INDEX OF REMEDIES. 



PAGE 

Extractum Nucis Vomicae 431 

Opii .571 

Physostigtnatis 629 

Podophyili 703 

Quassia? 167 

Ehei 696 

Stramonii 491 

Taraxaci 733 

Extracta Fluid a: 

Extractum Aconiti Fluidum 654 

Ailanthi Fluidum 668 

Belladonnas Fluidum 479 

Buchu Fluidum 732 

Calumbae Fluidum 168 

Chimaphila? Fluidum 732 

Cimicifuga Fluidum 476 

Cinchona? Fluidum 1 81 

Coca? Fluidum 511 

Colchici Badicis Fluidum 327 

" Seminis Fluidum 327 

— — Conii Fluidum 605 

Corniis Florida? Fluidum 168 

Cubeba? Fluidum 727 

Digitalis Fluidum 462 

Ergota? Fluidum 448 

Erythroxylon Fluidum 511 

Eucalypti Fluidum 174 

Gelsemii Fluidum 615 

Gentianse Fluidum 167 

Grindelia? Fluidum 665 

Guaranae Fluidum 520 

■ Hydrastis Fluidum 177 

Hyoscyami Fluidum 492 

Ipecacuanha? Fluidum 680 

Krameria? Fluidum 318 

Lupulini Fluidum 592 

Nucis Vomicae Fluidum 431 

Pareirse Fluidum 732 

Phytolacca? Fluidum 667 

Pilocarpi Fluidum 622 

Pruni Virginiana? Fluidum 171 

Quassia? Fluidum 167 

Ehei Fluidum 696 

Sabina? Fluidum 738 

Saneruinaria? Fluidum 335 

Sarsaparillae Fluidum 330 

" Compositum Fluidum 330 

Senna? Fluidum 695 

Serpentaria? Fluidum 171 

Spigeliae Fluidum 7J.5 

Stillingiae Fluidum 333 

Stramonii Fluidum 491 

Taraxaci Fluidum 733 

TJva Ursi Fluidum 732 

Ustilaginis Maidis Fluidum 461 

Valeriana? Fluidum 506 

Veratri Viridis Fluidum 659 

Xanthoxyli Fluidum 338 

F 

Faradism 408 

Faradic Electricity 408 

Fats and Oils 112 

Ferments 96 

Ferrum and its preparations 132 



PAGE 

Ferrum Dialysatum 134 

Filix Mas 716 

Firing 749 

Flax-seed 701 

Flexible Collodion 759 

Fluid Extracts (see " Extracta Fluida"). 

Fowler's Solution 154 

Friedrichshall 222 

Fumigations 8 

G 

Galazyme .' 38 

Galla 317 

Gallic Acid 317 

Galls 317 

Galvanism « 401 

Galvano-cautery 429 

Galvano-Faradization 401 

Therapy 419 

Gamboge 703 

Gargles 323 

Gaseoub Enemata 346 

Inhalations 346 

Gaultheria 395 

Gelsemine 615 

Gelsemium and its preparations 614 

Gentian 167 

Catesby's 167 

Geranium 31 S 

Glycerin 757 

Glycertta : 

Glyceritum Acidi Carbolici 319 

Amyli 757 

Vitelli 757 

Glycyrrhiza 762 

Gold and its preparations 279 

Gold in Metallotherapy 312 

Goldthread ,163 

Goulard's Extract 293 

Ointment 293 

Granatum 716 

Grape-Cure 4S 

Grindelia 665 

Guarana 520 

Guaiacum and its preparations 332 

H 

Hamamelis Virginica 319 

Hsematoxylon and its preparations 313 

Heat S2 

Hemlock 605 

Heuchera 319 

Hip-Bath 73 

Homburg Springs 222 

Homotropine 490 

Hope's Mixture 107 

Hops 592 

Humulus and its preparations 592 

Hydragogue Cathartics 706 

Hydrargyrum and its preparations 262 

Hydrastine 1 78 

Hydrastus and its preparations 177 

Hydrate of Chloral 564 

Hydrochloric Acid 103 

Hydrocyanic Acid 641 



INDEX OF REMEDIES. 



769 



PAGE ( 

Hydrogen dioxide 843 

Hydroquinone 376 

Hydrotherapy 73 

Hyoscine 495 

Hyoscyamine 492 

Hyoscyamus and its preparations 495 

Hypnone 541 

Hypodermatic Method 15 

Kemedies 18 



I 
Inftjsa : 

Infusum Brayera3 

Cinchonse 

Digitalis 

Pruni Virginianse 

Senna? Compositum 

Igasuric Acid 

Ignatia 

Infant-Feeding 

Ingluvin 

Inhalations 

Injections — Intravenous 

Iusufflation 

Inunction Method 112, 

Iodides 

Iodine and its preparations 

Iodoform 241, 

Iodo-tannin 

Iodol 

Ipecacuanha and its preparations 

Iridin 

Iris Versicolor 

Iron and its preparations 



431 
444 

53 



20 
6 
274 
243 
241 
254 
252 
260 
680 
705 
705 
132 



Jahorandi and its preparations 622 

Jalap and its preparations 701 

Jequirety 751 

Jervia 660 

Juniper and its preparations 730 

K 

Kairine 376 

Kairoline 376 

Kamala 717 

Kino and its preparations 318 

Kissingen 222 

Koumiss 37, 52 

Koussine 717 

Kousso 717 

Krameria and its preparations 318 



Lactic Acid 101 

Lactucarine 593 

Lactucarium 593 

Lard 112 

Laxatives 686 

Lead and its preparations 293 

Leptandra 704 

Leptandrin 705 

Licorice , 762 

Lime and its preparations 210 

50 



PAGE 

Lini Farina 761 

Linum and its preparations 761 

LlNTMENTA : 

Linimentum Ammonia? 224, 745 

Camphors? 500 

Cantharidis 745 

Chloroformi 546 

Saponis 500, 745 

Terebinthina? 718, 745 

Liquors : 

Liquor Ammonia? Acetatis 224 

Arsenii Chloridi 154 

Arsenii et Hydrargyri Iodidi 154 

Calsis 210 

Calcis Saccharatus 211 

Ferri Chloridi 1C3 

" Citratis 133 

" Nitratis 133 

" Subsulphatis 132 

" Tersulphatis 133 

Gutta-Percha? 759 

Hydrargyri Nitratis . 204 

Iodi Compositus 241 

Magnesii Citratis C9 1 

Morphina? Sulphatis 573 

>; Bimeconatis 573 

Pancreaticus 97 

Pepsina? 96 

Pluinbi Subacetatis 293 

Potassa? 201 

Potassii Arsenitis 154 

" Citratis 201 

Soda? 20S 

— Soda? Chlorinatae 344 

Sodii Arseniatis 154 

Zinci Chloridi 299 

Lithium and its preparations 212 

Lobelia and its preparations 639 

Lobeline 639 

Lupulin 592 

M 

Magnesia and its preparations 637 

Magnesii Carbonas 6S7 

Citras 691 

Sulphas 691 

Magnetism 400 

Magneto-Therapy 421 

Malt Liquors 536 

Manganum and its preparations 145 

Manna 6S6 

Massage 92 

Mel Eose 310 

Mercurial Inunction 274 

Fumigation 274 

Purgatives 694 

Mercury and its preparations 262 

Metallotherapy 310 

Methylal 538 

Methylene Bichloride 560 

Milk as a Beverage 68 

Milk as a Poison 55 

Milk -Diet 39, 53 

Mistur^e : 

Mistura Ammoniaci 506 



770 



INDEX OF REMEDIES. 



PAGE 

Mistura Asafcetida? 503 

Crete 211 

Ferri A romatici 134 

Ferri Composita 132 

« Laxans 134 

Gentians Alkalina 167 

" et Sennas 167 

Glycyrrhiza? Composita 304, 762 

MonsePs Solution 133 

Morphine and its Salts 573 

Mccilagines : 
Mucilago Acacia? 761 

Sassafras Medullar 761 

Tragacantha? 761 

Ulmi 7G1 

Mucuna 713 

Muriatic Acid 108 

Muscarine 669 

Mustard 744 

Myrica Cerifera 319 

Myrtol 396 

N 

Napelline 654 

Naphthalin .. . . 384 

Naphthol 385 

Narceine 572, 580 

Narcotine 572 

Nasal Douche 7 

Nicotianine 635 

Nicotine 635 

Nitre 201 

Nitric Acid 104 

Nitrite of Amyl 647 

Nitro-glycerin 650 

Nitro-Hydrochloric Acid 104 

Nitrous Oxide.. 562 

Nutrient Enemata 62 

Nux Vomica and its preparations 431 

Nymphaea Odorata 320 

O 

Oils and Fats 112 

Olea Destillata : 

Oleum Cajuputi 395 

Caryophylli 395 

Chenopodii 715 

Copaibas .725 

Cubebae 727 

Erichthites 172 

Erigerontis Canadensis 172 

Eucalypti 174 

Gaultheria? 395 

Juniperi 730 

Eicini 6S9 

Euta? 737 

Sabinae 733 

Tabaci 635 

Terebinthini 718 

Thymi 395 

Olcate of Mercury 263 

Oleatum ETydrargyri 263 

Yeratrina? 659 

Oleoresin.e : 
Oleoresina Capslci 729 



PAGE 

Oleoresina Cubebae 727 

Aspidii 716 

Lupulini 592 

Piperis 728 

Oleum Amygdalae Expressum 112 

Gossypii Seminis 112 

Lini 112 

Morrhuae 112 

Olivae 112 

— — Phosphoratum 119 

Eicini 689 

Theobromae 112 

Thymi 395 

Tiglii 707 

Valerianae , , 507 

Opium and its preparations 571 

Oxygen 341 

Ozone 342 

P 

Pancreatin 97 

Papaine 98 

Papaverine 572 

Paraldehyde 537 

Paregoric 571 

Pareira 732 

Parilline 331 

Parrish's Chemical Food 128 

Parsley 736 

Pelleterine 716 

Pepo 717 

Pepsin 96 

Peptones 97 

Peptonized Milk 97 

Gruel 97 

Perkins's Tractors 310 

Petroselinum 736 

Phenoresorcin 376 

Phosphates and Phosphites 128 

Phosphoric Acid 104 

Phosphorus and its preparations 119 

Physostigma and its preparations 620 

Phytolacca 667 

Picrotoxin 445 

Pictet Liquid : 347 

Pilocarpine Hydrochlorate 622 

Pilocarpus 622 

Pixttljs : 

Pilulae Aloes 69S 

" et Asafoetidae 504, 698 

" etMastiches 698 

" etMyrrha? 69S 

Antimonii Composita? 264 

Asafoetidae 503 

Cathartica? Composita? 702 

Copaiba? 725 

Ferri Carbonate (Massa) 132 

" Composita? 132 

" Iodidi.. 132 

Galbani Composita? 504 

Hydrargyri (Massa") 263 

Opii 571 

Phosphori 119 

Quinina? Sulphatis 181 

Ehei 696 



INDEX OF REMEDIES. 



771 



Pilulae Ehei Composite 696 

Scillae Coinpositae [unofficial] 735 

Pink-root 715 

Piper 728 

Piperin 728 

Pipsissewa and its preparations 732 

Plumbism 295 

Plumbum and its preparations 293 

Podophyllum and its preparations 703 

Polygonum Hydropiperoides 737 

Pomegranate 716 

Porter 536 

Potassii Cyanidum 645 

Permanganas 145 

et Sodii Tartras 201 

Potassium and its preparations 200 

Poultices 762 

Propylamine 620 

Prunus Yirginiana 171 

Prussic Acid 641 

Ptomaines 340 

Pulsatilla 664 

Puxveees : 

Pulveres Effervescentes 208 

Pulvis Aloes et Canellae 699 

Effervescens Oompositus 209 

Glycyrrhizae Compositus 687 

Ipecacuanhae et Opii 571 

Jalapae Compositus 701 

Morphinae Compositus 573 

Pulverization 9 

Pumpkin-seed 717 

Purgatives 686 

Pyridine 386 

Tricarboxyl 3S6 

Pyrocatechin 376 

Pyrogallic Acid 325 



Quassia and its preparations 167 

Quercus and its preparations 318 

Quinine and its Salts *. . 181 

Quebracho 673 

Quebrachine 673 



Easpail's Eau Sedatif 224 

Eeichenhall 223 

Eesin^e : 

Eesina Jalapae 701 

Guaiaci 332 

Podophylli 703 

Scammonii 702 

Eesorcin 373 

Ehatany and its preparations 318 

Eheum and its preparations 696 

Ehubarb 696 

Eosa Gallica and its preparations 319 

Eottlera , 717 

Eubefacients 744 

Eubus 319 

Eue 737 

Eussian Baths 71 



8 

Sabbatia 168 

Sabina 738 

Saccharin 387 

Sal Ammoniac 223 

Salicin 361 

Salicylate of Soda 362 

Salicylic Acid S62 

Saline Mineral-Waters 219 

Saline Purgatives 691 

Salix 361 

Salol 378 

Sanguinaria and its preparations 335 

Sanguinarine 335 

Sanguinarinic Acid 335 

Santonica 713 

Santonin 713 

Saratoga Springs, Waters of 219 

Sarsaparilla and its preparations 330 

Sassafras Medulla 761 

Savin 738 

Scammony and its preparations 702 

Scilla and its preparations 734 

Scoparius 732 

Seidlitz Powders 209 

Senna and its preparations 695 

Serpentaria and its preparations 171 

Sevura 112 

Silver and its preparations 2S1 

Sinapis Alba 744 

Nigra 744 

Sitz-Bath 73 

Smilacine 330 

Sodii Hypophosphis 128 

I Phosphas 128 

j Pyrophosphas 128 

Salicylas 362 

Sulphas 208 

Sodium and its preparations 208 

Sparteine 474 

Spigelia and its preparations 715 

Spieiti : 

Spiritus ^Etheris Compositus 542 

Athens Nitrosi 542 

Ammoniae 224 

Ammoniae Aromaticus 224 

Camphoras 500 

Chloroformi 546 

Frumenti 522 

Gaultheriae 395 

Juniperi Compositus 730 

Yini GaUici 522 

Squill 734 

Statice Limonium 319 

Static Electricity 398, 430 

Steam-Bath 83 

Stenocarpine 519 

Stillingia and its preparations 333 

Stillingin 333 

Stramonium and its preparations 491 

Strychnine and its Salts 432 

Strophantine 473 

Strophantus 473 

Styptic Colloid 317 

Sulphides 236 



772 



INDEX OF REMEDIES. 



PAGE 

Sulphites 234 

Sulphocarbolates 359 

Sulphur and its preparations 6S7 

Sulphuric Acid 103 

Sulphurous Acid 234 

Sulphurous Mineral-Waters 23S 

Suppositoeia : 

Suppositoria Acidi Tannici 317 

Syeupi : 

Syrupus Acaciae 761 

- Calcis 211 

Calcii Lacto-phosphatis 128 

Ferri Iodidi - 133 

" et Mangani Iodidi 134 

Hypophosphitum 128 

" cum Ferro 128 

Ipecacuanha? 680 

Lactucarii 593 

Mangani Iodidura 145 

Pruni Virginianae 171 

Ehei 696 

" Aromaticus 696 

Eubi 319 

Sarsaparillse Compositus 330 

Scillae 734 

" Compositus 304,734 

T 

Tabacum and its preparations 635 

Tannic Acid 317 

Taraxacum 733 

Tartar Emetic 304 

Tartaric Acid 232 

Tea 66 

Terebene 723 

Terebinthina 718 

Terpine . . 71S 

Terpinol 718 

Thebaine 572 

Thymol 395 

TINCTTTE.E : 

Tinctura Aconiti Eadicis 654 

Aloes 698 

« etMyrrhae 698 

Arnicae 619 

Asafcetidae 503 

Belladonna? 479 

Benzoini 3S9 

" Composita 389 

. Calumba? 168 

Cannabis Indicae 50S 

Cantharidis 739 

Capsici 729 

Catechu 31S 

Cimicifugae 476 

Cinchonae 1S1 

" Composita 181 

Colchici 327 

Conii 605 

Cubebae 727 

Digitalis 462 

Eucalypti 174 

Ferri Acetatis ^Etheria 134 

" Chloridi 133 

Gallae 317 



PAGE 

Tinctura Gelsemii 615 

" Gentiana? Compositae 167 

Guaiaci 332 

" Ammoniata 332 

Humuli 592 

Hydrastis 177 

Hyoscyami 492 

Ignatise 444 

Iodi 241 

Ipecacuanha? et Opii 680 

Jaborandi 622 

Kino 318 

Krameriae 318 

Lobeliae 639 

Lupulinae 592 

• Nucis Vomicae 431 

Opii 571 

" Acetata 571 

4i Camphorata 571 

" Deodorata 571 

Phosphori 119 

" JEtherialis 119 

Physostigmatis 629 

Phytolaccae 667 

Pilocarpi 622 

Pulsatilla? 664 

Quassiae 167 

Ehei . 697 

" Aromaticus 697 

" Dulcis 697 

Sanguinariae 335 

Scillae 734 

Serpentariae 171 

Stramonii 491 

Strophanti 473 

Valerianae 506 

Valerianae Ammoniata 506 

Veratri Viridis 659 

Tobacco 635 

Topical Eemedies 742 

Transfusion 22 

of Milk 25 

Peritoneal 26 

Tragacanth 761 

Trimethylamine 620 

Tbochtsci : 

Trochisci Acidi Tannici 317 

Cubebae 727 

Catechu 318 

Ferri Subcarbonatis 132 

Ipecacuanha? 6S0 

Morphina? et Tpecacuanhae 681 

Potassii Chloratis 201 

Santonini 713 

Trichlorphenol 360 

Tully's Powder 573 

Turkish Bath 84 

Turpentine 718 

Turpeth Mineral 263 

Tyrotoxicon 340 

U 

Ulmus 761 

Ungtjexta : 

Unguentum Acidi Carbolici 349 



INDEX OF REMEDIES. 



773 



PAGE 

TJnguentum Acidi Tannici ... 317 

Antimonii 304 

Belladonna? 479 

Benzoini 889 

Galbe 317 

Hydrargyri 263 

" Ammoniata 264 

" IodidiEubri 264 

" Nitratis 264 

" " Rubri 265 

" Oxidi Flavi 263 

" " Eubri 263 

Iodi 241 

Iodoformi 241 

Potassii Iodidi 241 

Plumbi Carbonatis 293 

" Iodidi 294 

Stramonii 491 

Tabaci 635 

Veratrinae 659 

Zinci Oxidi 299 

Urethan 539 

TTrino-Genital Remedies 718 

TJstilago Maidis 461 

Uva TJrsi 732 

V 

"Valerian and its preparations 506 

Vapor-Bath 83 

Vegetable Acids 232 

Vegetable Diet 40, 48 

Venesection 753 

Veratrine 660 

Veratroidia 659 

Veratrum Viride 659 

Vichy 217 

Vienna Paste 200 

Villate's Solution 302 



PAGE 

Vinegar 232 

Vina.: 

Vinum Aloes 698 

Antimonii 304 

Colchici Eadicis 327 

" Seminis 327 

Ergotae 448 

Ferri Amarum 134 

" Citratis 134 

Ipecacuanhas 680 

Opii 571 

Ehei 697 

Tabaci 635 

Vinum 531 

Album 531 

" Fortius 531 

W 

"Water 69 

Wet Pack 72 

Whey-Cure 52 

Whisky 522 

Wine 531 

Woorara 610 

Worm-seed 715 

X 

Xanthoxylin 338 

Xanthoxylum 338 

T 

Yellow Eoot ' 177 

Z 

Zinc and its preparations 299 

Zinci Phosphidum „ 119 

Zinci Sulphas 299,677 



CLINICAL INDEX 



Abdominal Plethoba. 

Aliment, water-free food, 5S; laxative diet, 67; 
grape-cure, 48. 

Cathartics, saline, 691; resin-bearing, 695; and 
hydragogue purgatives, 706. 

Saline Mineral Waters, 216, especially Saratoga, 
Vichy, and the purgative saline generally. 
Aboetion : 

Aurum, 280. The chloride, to avert the tendency 
to habitual abortion. 

Cornutine, 460. To increase uterine action when 
required. 

Opium, 583. To check uterine action, and Ergot, 
458, to restrain haemorrhage. 

Abortifacients, ergot, savine, rue, aloes, picrotox- 
ine, apiol, pilocarpus, colocynth, the hydragogue 
cathartics, etc., all dangerous to life when used 
in sufficient quantity to produce abortion. 
Abscess: 

Belladonna plaster, 489. Emplastrum ammo- 
niaci cum hydrargyro, 262 and 745. Leeches, 
754. Nitrate of Silver in nitrous ether applied 
over inflamed area and adjacent region to abort 
inflammation, 2S6, and ointments or powder of 
iodol, 260, and iodoform, 253. Tincture of 
Iodine as a counter-irritant, and as an antiseptic 
injected into the sac of an abscess, 252. Car- 
bolic Acid, 355, Salicylic Acid, 372, Resorcin, 
376, and Boracic Acid, 338, for antiseptic dress- 
ing. Sulphides, 237, gr. i every few hours to 
abort abscess, or hasten the formation and ex- 
trusion of pus. Potass, permangan., 147, as a 
deodorant and germicide. 
Acidttv : 

Mineral Acids, 106, before meals. Acid fermen- 
tation, with vomiting of pasty matter, sulphu- 
rous acid, 235. During meals an acid wine 
(Rhine). For immediate relief, alkalies after 
meals, 210. The frequent use of alkalies en- 
hances the mischief. Lime-water, 212. Car- 
bonate of Ammonia, 225. Alkaline Mineral- 
waters, 21S. Tannic Acid, 320, in pill-form— 
flj glycerin to gr. iv of tannin. Carbolic 
Acid, 353, stops fermentation and eructations. 
Bismuth, 152, with carbolic acid, gives excel- 
lent results. The purified black Oxide of Man- 
ganese, 146, and Oxide of Silt er, 284, are serv- 
iceable, acting as local sedatives and preventing 
acid fermentation. Acetate of Lead, 296, Kino, 



321, and Nux Vomica Tincture, 437, act in the 
same way, and rather remove the causes than 
affect the acidity directly. 

Acne : 
Phosphorus, 127. Even more effective and safer 
are the hypophosphites and phosphates. Ar- 
senic, 163 ; sometimes beneficial, but on the 
whole disappointing. Bismuth, 154, is an ex- 
cellent topical application when there are heat 
and redness. Sublimed Sulphur, 236, applied 
as a powder to the eruption is one of the best 
applications. Alkaline lotions, when the skin 
is greasy and the sebaceous follicles full, are 
useful; for example, liquor potassos in rose- 
water, 213. Lotions of corrosive sublimate, 
276. Glycerin, 758, internally. 

Adynamia : 
Alcohol, 528, is serviceable when it improves the 
appetite and digestion, when the tongue be- 
comes moist, and when delirium subsides under 
its use. Brandy is the best form when bowels 
are relaxed ; whisky when there is constipation. 
A wine of good body and high bouquet in the 
weakness of sedentary occupations. Aliment, 
60-65, beef, milk, cod-liver oil. Bitters, espe- 
cially calwnba, 167, and hydrastine, 177, as a 
substitute for quinine. Eucalyptus, 174, for ma- 
larial adynamia, but especially the alkaloids of 
cinchona, notably quinine, 130, gr. ij— gr. v, ter 
in die. Iron. 13S. to stimulate digestion and 
promote blood formation, with manganese. 
Chalybeate springs, 151. Xux Vomica Tinct- 
ure, 438, with capsicum in the case of inebri- 
ates. 
Coca, fluid extract, 515, prevents waste, and 
favors constructive metamorphosis. 

Afteb-pains : 

Chloral, 569, one of the most efficient remedies, 
but considerable doses necessary. Camphor, 
502, effective, with or without morphine. Gel- 
semium, 618, also stops after-pains; but, as 
large doses are necessary, safer remedies are 
preferable. Morphine and atropine, 590, sub 
cutaneously or by the stomach, very certain to 
relieve, 587. Cimicifuga, 478, affords some re- 
lief. 

Albttminubia : 
Milk cure, 52, especially buttermilk. 53. Iron, 
143. Basham's Mistura Ferri et Amnion ii 



CLINICAL INDEX. 



775 



Acetatis, and the purgative chalybeate waters, [ 
150, for the anaemia. Arsenic, 164, for the inter- | 
stitial changes in kidneys. Alkaline diuretics, 
207. Gallic acid, 322, especially Altken's for- I 
mula to restrain loss of albumen. Oxygen, 342. I 
Gold and Sodium Chloride, 280, in the chronic i 
forms. Nitroglycerin and Nitrites, 652, for 
high vascular tension. Pilocarpine,^. Digi- 
talis, 469, when quantity of urine much lessens. 

Alcoholism : 
Bromides, 598, especially for the " horrors," in 3 - 
doses. Capsicum, 729, for its stomachic tonic 
and hypnotic qualities. Chloral, 568, very effi- 
cient in the acute form, but caution is required 
in cases with weak heart and in old drunkards. 
Opium, 586, cautiously, and especiaUy with 
belladonna, 590. Zinc Oxide, 302, for the 
chronic state, with piperine or capsicum. Cin- 
chona, 196, especially the O. Eubra, fluid ex- 
tract. Lupulin, 592, fluid extract with capsi- 
cum ; good substitute for alcoholic stimulants. 
Picrotoxin, 447, for the muscular tremors. Nux 
Vomica, 438, nerve and stomachic tonic. Pilo- 
carpine, 626, very effective in acute attacks to 
induce sleep. 

Amaurosis : 
Strychnine, 440, hypodermatically, curative in 
functional disease caused by tobacco, alcoholic 
excess, etc. Pilocarpine, 626, and also Picro- 
toxine, 447. 

Amenorrhea : 
Aconite, 657, for sudden suppression due to cold. 
Aloes, 700, when due to anaemia and torpor. 
Iron, 142, when anaemia is the cause ; may be 
given with nerve-stimulants, as nux vomica, 
chalybeate waters, 150. Apiol, 736, and Hy- 
dropiper, 737, when there is functional inactiv- 
ity of ovaries, preceded by a chalybeate course, 
by aloes, apiol being given just before the period 
for several days. Arsenic, 164, as a reconstit- 
uent, combined with iron. Chloride of Gold 
and Sodium, 2S0, a stimulant of the menstrual 
function. Asafoetida, 505, for the nervous dis- 
turbance and as an ovarian stimulant. Elec- 
tricity, 427, faradic and static; very efficient to 
start the flow when suitable preparation has 
been made. Ergo*, 456, is useful when plethora 
exists. Rue, 737, and Savin, 739, are active 
stimulants, to be given with great caution. 
Pulsatilla, 654, used under the same circum- 
stances as aconite in sudden arrest of flow. 
Permanganate of Potassium and Salts of 
Manganese are the most effective stimulants of 
the menstrual flow, 147. 

An.emia : 

Compressed Air, 90. Oxygen, 342. Iron, 142. 
Arsenic, 164, an adjunct of iron, or when the 
latter can not be borne. Pepsin and Pan- 
creatine 99, to aid the primary assimilation. 
Zacto-phosphate of Lime, 130, a material need- 
ed in the anaemia of lactation and of suppura- 
tion. Manganese, 146, of use when associated 
with iron. Galvanization, 426, central, and 
general faradization, to stimulate the functions 
of organic life. Wines, 535, especially wines 
with good body. 



Anaesthetics : 
Kules for administration. 553. Morphine, subcu- 
taneously by the method of Bernard, 554, facili- 
tates the inhalation, lessens the dangers, and 
prolongs the anaesthetic stage with a less quan- 
tity of the anaesthetic. Whisky, 553, adminis- 
tered before inhalation, sustains the heart and 
prolongs the narcosis. Means of restoration, 
555, depressing head, drawing out tongue, arti- 
ficial respiration, inhalation of ammonia, or 
intravenous injection of the same, faradiza- 
tion of chest-muscles, electro-puncture of the 
heart, etc. 



Magnetism, 427, and Metallotherapy, 212, for 
the hysterical state, and for other forms, the 
electric brush, 427, and strychnine, 440. 
Aneurism : 

Aliment, 45, denutrition-cure. TufnelPs plan, 
47. Barium Chloride, 231, acts by raising the 
arterial tension, and has been used successfully. 
Iodides, 246, in full doses, relieve pain, and 
promote coagulation of blood in the sac. Ace- 
tate of Lead, 297, depresses the heart and 
raises the arterial tension. Veratrum Viride, 
662, slows the circulation, and thus facilitates 
coagulation in the sac. Aconite and other ar- 
terial sedatives act similarly ; but their action 
must be aided by a proper diet and absolute 
recumbency. Ergot, 456, especially ergotin 
subcutaneously, has been very effective. Gal- 
vano-puncture, 42S, has but rarely succeeded. 
Angina Pectoris : 

Amyl Nitrite, 649, by inhalation, affords prompt 
relief in cases characterized by elevated arterial 
tension, but must be used with caution when 
arteries are atheromatous and heart is fatty. 
Nitro-gtycerin, 653, acts similarly but more 
slowly, and is more manageable. Arsenic, 162, 
in full doses, is very efficient as a means of pre- 
vention. Ether, 544, in small quantity by in- 
halation, may abort a mild attack, hypoder- 
matically, in the worst cases, 545. 
Antidotes : 

For the Mineral Acids, 104. Alkalies, soda, 
lime-water, soap, and protectives, as oil,' mu- 
cilage, etc. For the systemic depression, al- 
cohol, opium, and especially carbonate of am- 
monia. 

For Phosphorus, 119. Emetic of sulphate of cop- 
per, French turpentine, or old. unrectified tur- 
pentine, hydrated magnesia, laxatives, trans- 
fusion. Oils and fats aid the absorption of 
phosphorus, but mucilaginous protectives are 
useful. 

For Arsenic, 155. Hydrated sesquioxide of iron, 
dialyzed iron, hydrated magnesia, emetics, the 
stomach-pump; opium and alcoholic stimulants 
for the systemic depression. 

For the Caustic Alkalies, 201. Diluted acetic 
acid, vinegar, soap, oil ; opium and stimulants 
for the sytemic depression. 

For Barium, 230. Emetics, protectives. hydrat- 
ed magnesia, tannin, especially diluted sulphuric 
acid ; nitrite of amyl and nitroglycerin to 
counteract the elevated arterial tension. 



776 



CLINICAL INDEX. 



For Sulphurous Acid and Sulphites, 234, and 
the Sulphides, 236. Weak acids, chlorine- 
water, sulphate of iron, common salt, etc. 

For Iodine and its poisonous compounds, 242. 
Starch is the antidote for iodine; but, as the 
iodide of starch is not without power, emetics 
should also be given. Albumen, starch, lime- 
water, tannin, soap, etc., should be used in poi- 
soning by iodides, and free emesis should be 
induced. 

For Iodoform, 257. 

For Mercury and its compounds, 265. Albu- 
men, the carbonated alkalies, tannin, lime-wa- 
ter, should be administered freely. Emetics 
should be given. For the usual systemic 
symptoms, opium, alcoholic stimulants, etc. 

For Gold and its Chlorides, 279. Same as for 
mercury. 

For Silver, 281. Common salt freely, albumen, 
tannin, and emetics. 

For Copper, 289, and Zinc, 299. Albumen, tan- 
nin, lime-water, soap, oil, and mucilage ; and 
the usual systemic remedies. 

For Lead, 294. Diluted sulphuric acid, alum, 
Epsom salts, milk; emetics and purgatives; 
iodides and bromides to secure elimination. 

For Antimony, 305. The vegetable astringents, 
tannin, albumen, oil, mucilage, and opium and 
stimulants to counteract the depression. 

For Mix Vomica and its Alkaloids, 432. Chlo- 
ral, ether and chloroform, gelsemium, bromide 
of potassium, are the physiological antagonists ; 
tannin is a chemical antidote. 

For Picrotoxin, 445. The physiological antago- 
nists and the antidotes are the same as for 
strychnia. 

For Ergot, 450. The caustic alkalies, aconite, 
but especially amyl nitrite. 

For Digitalis, 463. Aconite, saponaria, amyl ni- 
trite, and nitro-glycerin, are the physiological 
antagonists; tannin, sulphate and chloride of 
iron, are chemical antidotes. 

For Belladona and its alkaloid Atropine, 479. 
Opium or morphine, physostigma or eserine, and 
pilocarpine, are the most efficient antagonists. 
The caustic alkalies destroy the active prin- 
ciple, but the available chemical antidotes are 
tannin, compound solution of iodine, charcoal, 
etc. 

For Stramonium, Hyoscyamus, and Duboisia. 
The antagonists and chemical antidotes are the 
same as for belladonna. 

For Camphor, 500. Caffeine, the arterial seda- 
tives, etc. 

For Cannabis Indica, 509. Caustic alkalies, 
strychnine, faradic electricity. 

For Chloroform.— By the stomach, 546. The 
stomach-pump, oil and mucilage, atropine, fara- 
dism, artificial respiration, and cold affusion. 
By inhalation, 555. N61aton 1 s method (inver- 
sion of the body), drawing out the tongue, arti- 
ficial respiration, faradism, ammonia by inhala- 
tion and intravenous injection, amyl nitrite by 
inhalation, subcutaneous injection of tincture 
of digitalis and oxygen. 342, by inhalation. 

For Chloral, 564. Ammonia, atropine, galvan- 



ism, and heat, to overcome the cardiac depres- 
sion. Strychnine is the antagonist of Liebreich, 
but its range is limited. Eserine, to a slight 
extent, is physiologically opposed. 

For Opium, 574. The stomach-pump, or emetics 
(bicarbonate of sodium, followed by tartaric 
acid, has acted favorably); cold affusion, faradi- 
zation, and artificial respiration, when the res- 
piration flags ; belladonna, or atropine subcuta- 
neously, has acted favorably in numerous cases ; 
caffeine injected, or black coffee. 

For Conium, 606. Chemically the caustic alka- 
lies and tannic acid are antidotes; emetics or 
the stomach-pump, cold affusion, artificial respi- 
ration. Atropine and strychnine, subcutane- 
ously, to counteract the respiratory depression. 

For Curara, or Woorara, 610. Caustic alkalies 
and tannin act chemically ; artificial respiration 
is of the highest importance; atropine and 
strychnine counteract the respiratory failure. 
Cold affusion and emetics, or the stomach- 
pump, are necessary. 

For Gelsemium, 615. Chemically caustic alka- 
lies and tannic acid. Emetics, warmth, am- 
monia, faradization of chest-muscles, artificial 
respiration, and morphine, subcutaneously, are 
the important measures. 

For Pilocarpus, 622. The persalts of iron and 
the salts of metals are chemically antidotal. 
Atropine is, in a very complete degree, the 
physiological antagonist ; cardiac stimulants, as 
ammonia and alcohol, antagonize the cardiac 
depression. 

For Physostigma, 630. The vegetable astrin- 
gents and tannin, chemical antidotes. Physio- 
logical antagonists are, atropine to considerable 
extent— chloral, apparently, more completely. 
Faradization of chest-muscles and artificial 
respiration are important measures. Emetics 
should not be omitted. 

For Tobacco or Nicotine, 635. Emetics or 
stomach-pump. Tannin, compound solution of 
iodine, chemical antidotes. Ammonia, brandy, 
atropine, and strychnine to overcome failure of 
respiration; also, artificial respiration, cold af- 
fusion. 

For Hydrocyanic Acid and Cyanide of Potas- 
sium, 641, 645. Cold affusion to the spine, arti- 
ficial respiration, and the injection of atropine, 
are the best expedients. Emetics should be 
given if there is time. 

For Amyl Nitrite and Nitro-glycerin, 647, 
650. Ammonia, cold affusion, and artificial 
respiration, strychnine and atropine subcuta- 
neously, also ergot, a true physiological antago- 
nist. 

For Aconite and Veratrum Viride, 654, 660- 
Ammonia, alcohol, artificial respiration, heat, 
atropine, or morphine, subcutaneously; als<? 
digitalis. 

For Agaricin and Muscarine, 669. A com- 
plete antagonism exists between atropine and 
muscarine ; also, digitaline and eserine are an- 
tagonists. 

For Chlorine, 344. Ammonia for the gas, and 
albumen for the solution. 



CLINICAL INDEX. 



777 



For Carbolic Acid, 349. Saccharate of lime, or 
lime, is a chemical antidote. Oils and glycerin 
must not be given, but vegetable demulcents 
used freely. Atropine is a physiological an- 
tagonist of great value. Emetics should be 
used, and diluents. 

For Salicylic Acid and Besorcin, 362, 373. 
Arterial and respiratory stimulants prevent the 
cardiac depression, especially atropine. 

For the Hydragogue Cathartics, 706. Demul- 
cents, opium, and stimulants. 

For Turpentine, 719. Emetics, diluents, and 
demulcents. Opium is the most important 
remedy to counteract the local irritation and 
the cerebral effects. 

For Savin and Cantharides, 738. Emetics and 
demulcents. Opium to counteract the depres- 
sion and local inflammation ; also, stimulants 
and atropine for the cardiac depression. 
Antipybetics : 

Quinine, 191, first in importance, but must be 
given in full doses. Eucalyptus, 175, useful 
in chronic malarial poisoning. Digitalis, 466, 
chiefly useful as an adjunct to quinine. Sali- 
cylic Acid, or salicylates, 363, active and cer- 
tain antipyretics. Antipyrine, 381, Acetani- 
lide, 392, Salol, 380, Besorcin, 376, CMnoline, 
Katrine, and Hydroquinone, 377, are the 
more important of the new antipyretics. Cold 
Baths, 75, 76, the most powerful means of 
lowering temperature. Pilocarpine, 624^ re- 
duces fever after a preliminary stimulation. 
Of lesser importance are Aconite, 656, Gelse- 
mium, 61 6, and Phytolacca, 668. 
Antiseptics : 

Carbolic Acid, 356, Salicylic Acid, 372, Boracic 
Acid, Besorcin, 376, together with the new 
remedies mentioned above, and more recent 
acquisition of the same kind, grouped in the 
class Antiseptics, 340, are the most important 
for the antiseptic method. 
Aphonia. : 

Atropine, 486, is curative in hysterical cases, if 
given to induce some obvious constitutional 
symptoms. Nitric Acid, 109, is very effective 
in the hoarseness of singers, when the aphonia 
is reflex (cold, indigestion, etc.), and in fatigue 
of vocal cords. Electricity, 424, by an intra- 
laryngeal electrode, usually cures paresis of the 
vocal cords. 
Aphtha : 

Bismuth, 153, in powder directly to the ulcers. 
Coptis, 163, the infusion as a topical applica- 
tion. Chlorate of Potassium, 214, probably 
the most effective remedy, locally, and by the 
stomach; full doses are necessary. Iodoform, 
251, with or without Tannin, 258, and lodol, 
260. Naphthaline, 385, an excellent topical ap- 
plication. Quinine, 198, highly useful as a 
tonic. Muriatic Acid, 110, a local application 
to ulcers, formerly more employed than at 
present. Sulphurous Acid, 230, well diluted, 
in the form of spray. Carbolic Acid, 356, 
pure, applied to ulcers, an anaesthetic and al- 
terant. 
Apoplexy. (See Hemorrhage, Cekebeal.) 



Arthritis, Chronic Rheumatic : 
Alkalies, 206, especially lithium. Iodide of Po- 
tassium, 249. Cimicifuga, 478. Salicylates, 
371 ; especially in debilitated subjects, Salicy- 
late of Cinchonidine, 370. Salicin, 361. 
Salol, 380. Acetanilide, 394. Antipyrine, 
383. Arsenic, 163, persistently used in small 
doses. Cod-liver Oil, 116, with or without the 
phosphates. 

Ascarides : 
Quassia, 170, also Eucalyptus, 176, an infusion 
as a rectal injection, or by irrigation of the 
bowel. Carbolic Acid, 356, is an efficient but 
unsafe parasiticide when injected in the rectum. 
Iron, 143, the sirup of the iodide, by the stom- 
ach to prevent reproduction, and the tincture 
by rectal injection. Santonin, 714, at night, 
with or without calomel, and a laxative in the 
morning. Enema Aloes, 711. Hydrocyanic 
Acid, 644, for lumbricoides. Salicylic Acid, 
367, by enema and by stomach. Myrtol, 396. 

Ascites : 
Copaiba Besin, 726, has proved very efficient as 
a diuretic. Pilocarpine, 626, very service- 
able when given to produce free diaphoresis. 
Jalap, 701, in the form of the compound pow- 
der, most useful as a hydragogue cathartic. 
Elaterium, 709, also a hydragogue of great 
power; must be given cautiously, and not at 
all when gastro - intestinal irritation exists. 
Eemedies are more active when aided by a 
milk-diet, 52, or by dry diet, 47. 

Asthma : 
Air, compressed, 91. Oxygen, 342, pure or di- 
luted, by inhalation. Amyl Nitrite, 649, by 
inhalation, or Nitroglycerin, 652, by the 
stomach. Arsenic, 161, by the stomach, as a 
prophylactic, or by smoking in cigarettes. 
Bromides, 602, relieve in purely spasmodic 
asthma, but soon lose their effect. Chloral, 
56S, may arrest the paroxysms, but danger of 
chloral-habit. Chloroform, 547, by inhalation, 
dropped on warm water, relieves, but a habit 
is quickly formed. Last two remedies are dan- 
gerous in weak heart. Ether, 546, is safer and 
equally efficient by inhalation. Paraldehyde, 
538. Quebracho, 618, a new and valuable 
remedy in most forms of dyspnoea. Eyoscine, 
496. Belladonna, 4S3, in pastil es with stra- 
monium and other narcotics, gives temporary 
relief, but Atropine, hypodermatically, is more 
efficient. Morphine, 588, and atropine sub- 
cutaneously, give more decided and lasting 
relief than any other remedies. Grindelia, 
665, is a most useful remedy, next in value as 
a means of immediate relief to morphine and 
atropine. Iodide of Potassium, 246, in full 
doses, succeeds remarkably in some cases. 
Ethyl Iodide, 254. Quinine, 197, as a tonic 
after the acute symptoms and as a prophylactic 
in the interval. Strychnine, 440, is indicated 
when there is weakness of respiratory muscles. 
Pyridine, 886, a new and effective remedy- 
by inhalation. Galvanization, 426, of the 
pneumogastric and cervical sympathetic re- 
lieves the spasmodic difficulty of breathing, 



CLINICAL INDEX. 



and sometimes effects a cure, and faradiza- 
tion of the chest-muscles has lately been re- 
ported successful in effecting a cure. Tartar 
Emetic, 807, and Lobelia, 640, carried to slight 
nausea in cases of deficient secretion of bron- 
chial mucus. Pilocarpus, 026, subcutaneously 
in spasmodic asthma. 

Astigmatism : 
Atropine, 486, a weak solution to facilitate ex- 
amination. Hyoscine, 496. Duboisine, 498, a 
substitute. Eserine, 634, in some cases. 

Atheboma of the Vessels : 
Arsenic, 163, indicated when eyes are puffy, 
breathing short, and ankles swollen. Phos- 
phorus, 126, in minute doses for the weakness 
and mental failure associated therewith, with 
or without Cod-liver Oil, 117, which may also 
be advantageously combined with phosphates 
and hypophosphites. Ammonia Carbonate, 
226, to dissolve thrombi. Quinine, 196, is of 
great service, administered in a full dose daily 
for a time. 

Bed-sores : 
Alcohol, 530, a wash to skin. Alum, 316, with 
tincture of camphor and whites of eggs, a good 
topical application. Bismuth Salicylate, 154. 
Rezorcin, 376, in form of powder. Copaiba, 
726, and Castor- Oil, equal parts, but Naphthol, 
385, is said to be the most efficient of all. A 
galvanic couplet, zinc and silver, connected 
with a copper wire, has been used with suc- 
cess, 429. 

Biliabt Calculi. (See Calculi.) 

Biliousness : 
Acids, Mineral, 106, before meals in acid indi- 
gestion. Hydrochloric acid and pepsin after 
meals in atonic dyspepsia. Alkalies, and their 
laxative salts, 206, and Alkaline Mineral- 
Waters, 216, 219, when the uric acid is in 
excess. Sodium Phosphate, 129, especially 
useful. Aloes and the resin-bearing cathartics, 
699, Cholagogues, so-called, Euonymin, 705, 
Iridin, 705, Baptisin, 706, etc., to promote 
biliary evacuations. Calomel and blue pill, 
246, in small quantity as laxatives merely. 
Ammonium, Chloride, 226. Manganese, 146, 
in gouty subjects. Iodide of Ammonium, or 
iodine, 247, in the biliousness of the malarial 
cachexia. Hydrastis, 179, Stillingia, 334, and 
the bitters, also Tincture of Mix Vomica, 
438, after the action of saline or resinous 
cathartics. Milk-Diet, 52, 69, Whey - Cure, 
52, Koumiss, 53, of high importance. 

Bites of Venomous Snakes : 
Ammonia, 229, Bromine, 346, locally to the 
wound. Permanganate of Potassium, 147. 
Alcoholic Stimulants, 477. Chlorinated 
Lime, 321. 

Bladder, Cataerh of: 
Alkalies, 207, after meals, when urine is acid- 
Benzoate of Ammonia, 390, when urine is 
alkaline. Copaiba, 726, Cubebs, 72S, Juniper, 
732, and other urino-genitals, are useful, but 
liable to damage kidneys. Cantharides Tinct- 
ure, 741, ver}' efficient in small doses. Boro- 
tartrate and Borocitrate of Magnesia, 3SS, 



have proved highly useful. Eucalyptus, 176, 
and Turpentine, 723. Quinine, 196, very 
beneficial when there is septicemic fever. 

Bladder, Irritability of: 
Belladonna, 480, of special utility in nocturnal 
incontinence, but must be carried to the pro- 
duction of physiological effects. Cantharides 
Tincture, 741, sometimes succeeds remarkably 
in irritable bladder of women. Aqua-punct- 
ure, 750, often curative. When urine is acid, 
Alkalies, 207; when alkaline, Benzoate of Am- 
monia, 390. 

Boils : 
Arsenic, 163, long continued for a succession of 
boils. Nitrate of Silver, 287, dissolved in 
nitrous ether, and painted on early will abort. 
Sulphides, 237, in small doses frequently, either 
stop formation or push to maturation and dis- 
charge of pus. Sulphurous Waters, 239, act 
in same way. Phosphates, 136, suitable tonics. 

Bone Diseases ; Softening of Bone : 

Carbonate and Phosphate of Lime, 130, are 
materials necessary. Phosphorus, 125, pro- 
motes formation of bony tissue. Phosphates, 
130, improve tissue formation in general. Cod- 
liver Oil, 107, in combination. Chloride of 
Calcium, 212, in strumous subjects. (See also 
Caries, Rickets.) 

Breath, Foul : 

Chlorine- Water, 344, properly diluted. Car- 
bolic Acid, 356, in dilute solution, as a mouth- 
wash, and by the stomach. Potassa Perman- 
ganate, 147, in rose-water as a mouth-wash. 
Benzoic Acid and Tincture of Benzoin, 390, 
topically and internally. 

Bright's Disease: 
Milk-Cure, Koumiss, Whey, 51, 53, have been 
very successful, especially an exclusive skim- 
milk diet, or a diet composed largely of milk. 
Water, 74, and large draughts of weak alkaline 
waters. Bitartrate of Potassa, 207, as lemon- 
ade, drunk freely as a diuretic. Digitalis, 469, 
the infusion for dropsy. Iodide of Potassium, 
246, in cases of chronic kind (especially if 
there is a syphilitic taint\ and in arterio- 
sclerosis. ' Iron, 134, the tincture of the chlo- 
ride, well diluted, or in Basham's mixture, to 
stimulate the kidneys and to relieve the ac- 
companying anemia. Pilocarpus, 626, highly 
useful in many cases of uraemia. Aurum, 280, 
in chronic interstitial nephritis and amyloid 
kidney. Cantharides, 741, Eucalyptus, 176, 
and other urino-genitals, but are doubtful. 
Kitro-glycerin, 653, has proved highly useful 
when there is increased vascular tension. 

Bbonchitis, Acute : 
Muscarine, 672, at the onset of the disease may 
arrest. Aconite, 658, in small dose frequently. 
Tartar Emetic, 307, in moderate quantity, 
with or without morphine. Nitric Acid di- 
lute, 109. Cimicifuga. 477. an expectorant, may 
be combined with opium and aconite. Ca?"- 
bonate of Ammonia, 228, if secretion is viscid 
and there is depression. Sanguinaria, 337, 
and Lobelia, 641, nauseating expectorants, best 
given with opium. Terebene for cough, 724, 



CLINICAL INDEX. 



779 



a Dew and valuable remedy. Morphine, or 
Dover 's Powder, with quinine, 583, may abort 
if given early enough. Pilocarpus, 626, often 
highly useful at the beginning. For mild cases, 
Sirup of Squills, 735, or the compound sirup, 
with Paregoric, makes a useful combination. 
Ipecac, 680, as expectorant. 

Bronchitis, Capillary: 
Iodides, 247, diminish the viscidity of the secre- 
tion, and thus lessen one of the chief dangers. 
Carbonate of Ammonia, 228, acts similarly, 
and is indicated when depression comes on. 
Ethyl Iodide, by inhalation, 254. Serpentaria, 
. 172, a stimulating expectorant, may be given 
with ammonia. Turpentine, 722, when the 
capillary circulation languishes. Terebene, for 
cough, 724. Camphor, 502, also under the 
same circumstances. Emetics are highly use- 
ful, the Subsulphate of Mercury, 627, Alum, 
677, and Apomorphine, 679, being the prin- 
cipal. Pilocarpus, 626, when there is much 
secretion. Pyridine Vapor, 386. 

Bronchitis, Chronic : 
Koumiss, 52, 64, a valuable nutrient. Cod-liver 
Oil, 115. Iron, 132, especially the mistura 
ferri composita. Chloride of Ammonium, 

228, combined with stimulating expectorants, 
as Eucalyptus, 176, or Serpentaria, 172, or 
Sanguinaria, 337. The Iodides, 246, espe- 
cially the iodide of ammonium, is serviceable 
in combination with the expectorants just 
named. Morphine, 584, especially morphine 
and atropine, 590, or some preparation of opium, 
is indispensable to quiet cough. Strychnine, 
441, and the sirup of the phosphate of iron, 
quinine, and strychnine, is a valuable respira- 
tory stimulant. Strychnine is the best remedy 
to check the reflex vomiting. Inhalations of 
Sulphurous Acid, in spray or gas, 235, espe- 
cially Pictet liquid, 347, and gaseous enemata 
of Carbolic- Acid and Creosote, 354. Ben- 
soates also, 390, are very useful. Grindelia, 
666, a valuable expectorant, especially when 
the cough is troublesome. Copaiba, 726, 
and Cubeb, 728, useful stimulating expecto- 
rants. 

Bronchorrhcea : 
Eucalyptus, 176. Turpentine, 664, 723, its deriv- 
atives and the stimulating expectorants men- 
tioned under chronic bronchitis. Carbolic 
Acid, 354, internally and by spray. Grinde- 
lia, 666, Muriate and Carbonate of Ammonia, 

229. Cubeb, 728, Copaiba, 726. Sulphurous 
Acid, spray, 235, and as Pictet liquid, 347. 
Benzoin, inhalation, 391. Terebene, 724, anti- 
septic; eliminated by the lungs. Cod-liver 
Oil, 115. Alcoholic Stimulants, 530. Oxygen 
by inhalation and gas enemata, 347. Iodides, 
246. Phosphates as restoratives, 131. 

Burns and Scalds: 

Carbonate of Soda, 214, in saturated solution to 
relieve pain. Boracic Acid, 388, most useful 
in Mr. Lister's hands. Carbonate of Lead, 
298, painted on. Turpentine, 723, mixed with 
basilicon -ointment. Salicylic Acid, 372. Car- 
bolic Acid, 356, one-per-cent solution relieves 



pain and prevents suppuration. . Collodion, 
760, the flexile for slight burns. 

Cachexia : 
Aliment, 59, of first importance. Air, 90. Mas- 
sage, 94. Oils and Fats, 116, and oil inunc 
tions. Iron, 139, and Chalybeate Waters, 150, 
Manganese, 146, especially Sirup of the Io 
dide of Iran and Manganese. Arsenic, 164 
Phosphates, 131. The Simple Bitters, 170, 
Eucalyptus, 176. Hydrastis, 179. Quinine, 
190. 

Calculi, Biliary : 
Aliment, 69. Starches, sweets, and especially 
fats, should be avoided. Alkaline Mineral 
Waters, 218, highly useful. Phosphate of 
Soda, 130, persistently used. Turpentine, 
and Ether, 720, remedy of Divrand. For the 
paroxysms, see Colic. 

Calculi, Eenal : 
Alkalies, 207, 210, 388, when the calculi are com- 
pounds of uric acid with potash, and not soda 
salts. Also, Alkaline Mineral-Waters, 221, 
222, Vichy, Bethesda, etc. Bensoate of Am- 
monia, 390, for the solution of phosphatic cal- 
culi. Very long-continued use of the solvent 
necessary. Borocitrate of Magnesia, 388, sol- 
vent for uric-acid calculi. Tartroborate of 
Potassium, 388, probably still more efficient. 

Cancer : 
Arsenic, 165, relieves the pain and retards the 
growth of carcinoma of the stomach, and also 
of epithelioma. Bismuth, 154, relieves the 
vomiting in cancer of the stomach ; also, Car- 
bolic Acid, 355, especially by the method of 
parenchymatous injection. Potassa Chlorate, 
214, Salol, 381, Iodol, 260, JVaphthol, 384, and 
Terebene, 724, applied in powder alters the ul- 
cerated surface. Iodoform and Salicylic Acid, 
372, also in powder to the surface of the can- 
cer. Zinc Chloride and Sulphate dried, 
302, are efficient caustics. Potassa Fusa, 214, 
Chromic Acid, 756, and Bromine, 346, also 
active escharotics for the destruction of morbid 
growths. 

Caries : 

Cod-liver Oil, 116, to promote constructive met- 
amorphasis. Phosphates. 130, and Carbonate 
of Lime, 212, furnish needed materials. Chlo- 
ride of Calcium, 212, is useful in the strumous 
cachexia. Phosphorus, 125, promotes bone 
formation. Villatte's solution used to dissolve 
carious bone. 

Catarrh, Acute ; Common Cold : 
Aconite, 656, for the preliminary fever, with 
Belladonna, 483, when secretion is excessive. 
Quinine and Morphine, 190, 590, may, at the 
outset, abort an attack. Ipecac, especially the 
fluid extract, 682, alone or in combination with 
opium and aconite. Tartar Emetic, 307, in 
minute doses with morphine, is very useful. 
Dover Poioder, 588. at the inception may ar- 
rest the attack. Iodides, 247, a small dose 
very frequently, and Inhalations of Iodine, 
263, and of Ethyl Iodide, 255. Ammonia, 
226, carefullly inhaled at the outset of the dis- 
ease. Pulsatilla, 665, acts similarly to aco- 



■80 



CLINICAL IXDEX. 



nite. buj is contra-indicated if gastro-intestinal 
irritation exist. 

Catarrh, Broncho- Pulmonary: 
Air, compressed, 91. Alum, 315, by insuffla- 
tion. Aconite, 656, when attack is recent; 
Belladonna, 483, when secretion is profuse. 
Eucalyptus, 176, Hydrastis. 179, Sanguina- 
ria, 337, and Prunus Virginiana, 172, after 
the acute symptoms hare subsided. Also, Cu- 
beb, 72S, Copaiba, 726, Turpentine, 720, and 
Terebene, 724, Carbolic Acid, 355, of great 
value by inhalation of vapor and spray. 

Catabrh, Chronic Nasal : 
Alum, 315, in powder by insufflation. Iodoform 
and Tannin, 251, also applied in powder by 
insufflation. Iodine, 252, iD vapor inhaled; 
also Bromine. 346, but it must be inhaled very 
cautiously. Ethyl Iodide, by inhalation, 254. 
Sanguinaria, 337, the tincture internally and 
the powder locally. Cubeb, 72S, in powder by 
insufflation and troches. Also, Pyridine, 336, 
and Hydrogen dioxide, 343. 

Catarrh, Gastric. (See Gastric Catarrh.) 

Catarrh, Intestinal. (See Dysentery and Di- 

ARRHCBA.) 

Catarrh, Genito-Urinary. (See Bladder, Ca- 
tarrh of, Cystitis, Gonorrhoea, Leucoebhcea, 
Prostorrhcea, Endometritis, etc.) 

Cerebral Anaemia : 
Iron, 138, and Chalybeate Mineral- Waters, 150 
Galvanism, 422, by transverse applications. 
Phosphorus, 126. and Phosphates, 131, Qui- 
nine, 190, Strychnine, 440, and the cerebral 
excitants, Caffeine, 513, Guarana, 521, etc. 
Arsenic. 162, is highly efficient in some hypo- 
chondriacal cases; also, Aurum, 270, Amyl 
Nitrite. 643. Nitro- Glycerin. 652. and Ammo- 
nia, 226, afford relief in sudden attacks by di- 
lating vessels. 

Cerebral Congestion : 
Aconite, 657, Cold Douche, 79, alternate hot and 
cold applications. Bromides, 593, highly use- 
ful. Ergot, 457, Gelsemium, 617, Hydrocy- 
anic Acid, 644, and the arterial sedatives, Ve- 
ratrum Viride, 663, Digitalis, 463. etc. Gal- 
vanization of the cervical sympathetic, 423. 
Venesection, 754. is a suitable remedy in cases 
threatening rupture of vessels. Active Ca- 
thartics, 592, Colchicum, 329, lessen blood- 
pressure and act by derivation. 

Cerebbo-Spinax Meningitis : 
Aconite Tincture, 657, carried to arterial de- 
pression before exudations. Ergot, 457, also 
for first stage or period of congestion and irri- 
tation. Gelsemium, Fluid Extract, 617, for 
same period. Opium, 584. is the most effect- 
ive remedy. Quinine, 192, full cinchonism 
at the onset of the disease. Cold Baths, 76, 
77, for hyperpyrexia. 

Chancre. (See Syphilis.) 
Bromine, 346, Chromic Acid, 756, Nitric Acid, 
110, and Acid Nitrate of Mercury, 276, effi- 
cient escharotics for the destruction of chan- 
cre. Iodoform, 253, and Iodol, 260, with or 
without Thymol, 396, are excellent applica- 
tions dusted over sore. Carbolic Acid, 356, 



applied pure in mild cases. Iodide of Iron, 
139, internally in cases of systemic depression, 
or sloughing phagedena. Chlorate of Potas- 
sa, 214, in powder, is also an excellent local ap- 
plication. 

Chilblains : 

Turpentine, 723, and still more efficient Tere- 
bene, 724, Tincture of Iodine, 252, Carbolic 
Acid, 356, with iodine and tannin. Sulphur- 
ous Acid, diluted with glycerin, 235, is an ex- 
cellent application. Benzoin Tincture, 390, 
the first in value. 

Chloroform Narcosis. (See Antidotes, Nab- 
cosis.) 

Chlobosis: 
Arsenic, 161, as an adjunct to, or substitute for, 
iron. Oxygen, 342, inhaled. Iron, 138, with 
or without Manganese, 146, or arsenic; with 
aloes if constipation exist. Chalybeate 
Springs, 150. Massage, 94, oil inunctions, 
115, and faradization. Galvanization, 426, to 
central nervous system. Nux Vomica, or 
strychnine, 433, stimulates the blood-making 
organs ; may be combined with iron. Pepsin 
and Pancreatin, 99, improve digestion. 

Choleba Asiatica : 
Acetate of Lead, 296, an excellent astringent, 
usually given with opium and camphor. Cam- 
phor, 501, the saturated tincture. Carbolic 
Acid, 353, with or without iodine. Chloral, 
567. is highly effective by subcutaneous injec- 
tion ; usually combined with morphine. Chlo- 
roform, 547, a few drops frequently to stop 
vomiting, and Chlorodyne, 349. Opium, 532, 
especially useful to arrest preliminary diarrhoea. 
Calomel, 270, minute doses will sometimes 
stop vomiting. Alcohol, 523, as iced brandy 
or champagne to arrest vomiting and stimulate 
the heart. Sulphuric Acid, 107, with opium 
tincture, an excellent remedy for cholera diar- 
rhoea. Arsenic, 161, Fowler's solution with 
opium, sometimes valuable. Strychnine, 438, 
has been used with success in some epidemics. 
Atropine, 483, to stimulate the heart in cholera 
asphyxia. Intravenous Injection of Salines, 
21. in the algid stage, and of Mil A; 25. 

Cholera Morbus : 
Morphine and Atropine, 584, hypodermatieally, 
the most efficient remedy. Chloral, 567, with 
morphine if cramps occur. Carbolic Acid and 
Bismuth. 353. in an emulsion together, are suf- 
ficient in mild cases. The remedies for Chol- 
era A. 

Cholera Infanttm : 
Aliment, 55, is of the highest importance. See 
Poisonous Milk and Cream. 55, which should 
be read. Carbolic Acid, 353, with or without 
bismuth, is very effective. Bismuth, 153. is fre- 
quently prescribed in an emulsion. Oxide of 
Zinc, 301. Calomel. 271, in minute doses, ar- 
rests vomiting. Sulphate of Copper, 291, is an 
effective remedy, but only the smallest doses 
are admissible. Bromide of Potassium. 597, 
and the Cold Bath. 77. 75, are highly useful in 
cases characterized by nervous irritability and 
feverishness. Ipecacuanlia, 683, Is a desirable 



CLINICAL INDEX. 



781 



remedy when the stools assume a dysenteric 
character. Brandy, 528, renders important 
service in most cases, but full doses are neces- 
sary. Camphor, 501, is indicated when de- 
pression is marked ; it may be given in milk. 
Nitrate of Silver, 265, beneficial after the acute 
symptoms. Opium, 5S2, must be given with 
great caution. 

Chordee : 
Camphor, 501, successful if given in sufficient 
quantity ; may be administered with lactuca- 
rium. Bromides, 601, occasionally give relief. 
Cantharides Tincture, 741, in small dose, is 
said to be useful. Morphine and Atropine, 
585, subcutaneously, is the most certain. Col- 
chicum, 330, in a nightly dose, will succeed 
by inducing some nausea. Tartar Emetic, 
308, will relieve if carried to nausea. Tobacco, 
Wine of, 638, a few drops at bed-hour. Lupu- 
Une, 593, not powerful. 

Chorea : 

Water, 78, cold affusion and cold baths. Iron, 
139, especially subcarbonate, for the condition 
of anaemia and amenorrhoea. Cod-liver Oil, 
117, when the nutrition is poor. Arsenic, 162, 
one of the most certain remedies, but large 
doses are required, and well borne. Strych- 
nine, 440, and especially Picrotoxin, 447, in 
full doses when the nervous element is pre- 
dominant. Cimieifuga, 478, useful in some 
cases, but it is uncertain, and must be pushed 
to get the best results. Conium, 608, especially 
succus conii, has been strongly urged by Har- 
ley. Morphine, 586, in the large doses ad- 
vised by Trousseau, and Chloral, 569, especially 
at night, are highly useful. Static Electricity, 
426, has lately been revived. Magnets, 421. 
Metallotherapy 315. Chloride of Calcium, 
212, has done good in strumous subjects. Can- 
nabis Indica, 510. 

Cirrhosis : 
Iodides, 245, with or without arsenic, are useful 
in first stage. Phosphate of Soda, 131, per- 
sistently administered, of real value if com- 
menced early. Chloride of Gold and Sodium, 
280, has seemed to have curative power if given 
in time. Arsenic, 161, also retards if does not 
arrest over-growth of connective tissue. Stil- 
Ungia, 334, and Hydrastis, 179, in incipient 
disease, secondary to intestinal catarrh. 

Colic : 
Asafoetida, 505, in the flatulent colic of infants. 
Chloroform, 547, useful in flatulent colic and 
in hepatic, a few drops frequently. Ether, 544, 
556, internally and by inhalation. Camphor, 
501, a few drops of the saturated tincture 
frequently. Infusum Tabaci, 638, as an ene- 
ma, effective but dangerous. Morphine, 581, 
and Morphine and Atropine, 590, hypoder- 
matically, the most prompt and successful 
remedy. 

COLICA PlCTONTTM : 

Alum, 314, overcomes the constipation with suc- 
cess ; may be given with dilute sulphuric acid. 
Sulphuric Acid, 109, verv dilute in " lemon- 
ade," as prophylactic and as a curative agent. 



Morphine, 587, and Morphine and Atropine, 
591, subcutaneously, relieves pain most quick- 
ly. Iodides, 249, and Bromides, 598, to cause 
excretion of lead. Sulphate of Magnesia, 692, 
to overcome constipation. 

Colic, Hepatic : 
For the pain — Morphine and Atropine, 591, 
subcutaneously. Spirit of Chloroform, 547, 
Ether, 544, internally and by inhalation. Nitro- 
glycerin and Amyl Nitrite, 591, 649, 652. 
Tobacco, 637, for pain by relaxing spasm. For 
the calculi— Aliment, Phosphate of Soda, 131. 
Bemedy of Durande, 720. Alkaline Miner- 
al- Waters, 219. (See Calculi, Biliary.) 

Condylomata : 
Calomel, also lodol, 259, dusted over. Iodo- 
form, 256, 276, 277, powder applied freely. 
Carbolic Acid, 356, a mild escharotic for sim- 
ple cases. Chromic Acid, 756, in paste to de- 
stroy ; solution of bichromate of potassa a use- 
ful lotion. Nitric Acid, 111, a dilute solution 
as a wash. 

Conjunctivitis : 

Calomel, 277, dusted over membrane. Yellow 
Oxide of Mercury, 277, an ointment of, with 
vaseline, a most efficient remedy for granular 
lids. Tannin, 323, in powder dusted over 
membrane, an excellent application. Bismuth, 
154, also applied in powder directly. Copper 
Sulphate, 292, a smooth crystal applied direct- 
ly, an approved remedy. Silver Nitrate, 268, 
a long-standing, useful agent. Zinc Sulphate, 
303, a weak solution in rose-water, one of the 
best remedies for simple conjunctivitis. Cad- 
mium, 309, in solution, a substitute for copper 
and zinc. Fluid Extract of Ergot, 457, ap- 
plied undiluted, is said to be very efficient. For 
granular lids, Jequirety, 752, which sets up 
substitutive inflammation. 

Constipation : 
Aliment, 59, highly important in habitual : bread 
of unbolted flour, corn -meal bread, fruits, and 
succulent vegetables. Cathartics, 686. Physi- 
ological laxatives ; Arsenic, 161. small doses of 
Fowler's solution increase action. Nux Vomi- 
ca, 438, Physostigma, 631. Belladonna, 482, 
Tabaci Vinum, 637, a few drops at bed-time. 
Muscarine. 672, all act by either increasing se- 
cretion or muscular action, or both. Faradi- 
sation, 420, of intestines. Saline Mineral- 
Waters, 219, 221. and the purgative Sulphurous 
Waters, 241. Enemata, 710. 

Convalescence : ' 
Ebumiss, 37. Galazyme and Kefyr, 38, valu- 
able reconstituent stimulants. Bitters, 169, the 
simple, especially calumba and gentian. Euca- 
lyptus, 175, a tonic of special utility after ma- 
larial diseases. Hydrastis, 179, tonic, and use- 
ful substitute for quinine. Cuca, 515, atonic 
and stimulant of the nervous system; also, 
Guarana, 521, belonging to the same class. 
Iron, 138, especially sirup of the iodide, the 
carbonate, sulphate, and tincture of the chlo- 
ride. Phosphates. 131, and Phosphites, 130. 
Cod-Uver Oil, 151, Pepsin, 96, and Pancrea* 
tin, 98. Wine, 534. 



782 



CLINICAL INDEX. 



Convulsions : 
Anaesthetics, 556, in ura?mic and puerperal con- 
vulsions. Bromides, 59S, in epileptic and epi- 
leptiform. Chloral, 567, in puerperal, ursemic, 
and epileptiform. Morphine, 5S6, hypoder- 
rnatieally, in full doses, in ursemic convulsions. 
Veratrum Viride, 663, in puerperal. 

Cough : 
Asafoztida, 505, in cough by habit, bronchorrhcea 
and chronic bronchitis ; also, under same con- 
ditions, ammoniac, cubeb, copaiba, turpentine, 
etc. Chloral, 569, in spasmodic cough, cough 
by habit, whooping-cough, etc. Gelsemium, 
617, useful to quiet a nervous element in cough. 
Lobelia, 641, a nauseating expectorant of great 
utility in dr3 r cough, bronchitis, asthma, etc. 
Tereberie, 724, Paraldehyde, 53S, Pyridine, 
3S6, Erigeron Oil, 173, valuable remedies of re- 
cent origin. Cerium, 309, in cough associated 
with, or reflex from, stomach derangement. 
Omum, 5SS, in some form, of chief utility as a 
means of quieting cough. Prunus Virgini- 
ana, 172, anodyne and tonic expectorant. Hy- 
drocyanic Acid, 642, indicated in cough of 
irritation, habit, reflex, and stomachal. Grin- 
delia, 666, especially useful in spasmodic cough, 
and as a stimulant expectorant in chronic bron- 
chitis. Lactucarium, 593, sirup, an excellent 
vehicle for cough - mixtures. Ipecacuanha, 
685, especially the fluid extract, an excellent 
nauseating expectorant. 

Croup. (See Laryngismus Stridulus.) 
Alum, 316, not depressing. Mercury Subsul- 
phate, 677, the most efficient emetic in croup. 
Calomel, 272, by some supposed to be sedative 
and aplastic, allaying laryngeal spasm and pre- 
venting formation of membrane. Sulphate of 
Copper, 291, Sulphate of Zinc, 301, as emetics 
inferior to turpeth mineral. Tartar Emetic, 
306, causes dangerous depression in young chil- 
dren. Apomorphine, 679. effective but may be 
dangerous. Quinine, 197, in large doses high- 
ly useful. Lactic Acid, 102, a solvent of false 
membrane, applied in spray or directly. Car- 
bolic Acid, 357, in spray. Lime- Water, 212, 
and steam from slaking lime. Ipecac, 682, as an 
emetic. Ethyl Iodide Vapor, 253, Pyridine, 
386, Eucatyptol, 176, and Turpentine Vapor- 
ized, 722. 

Cysts : 
Iodine, 252, tincture or compound tincture of, 
injected, is effective, titrate of Silver, 2S8, a 
solution injected into cysts to excite adhesive 
inflammation. Galvano-puncture, 423, will 
usually permanently occlude. 

Cysts, Hydatid, of Liver or elsewhere : 
Iodine Injections, 252. Galvano-puncture, 428. 
Simple Acupuncture, 6S9, and escape of some 
fluid, often suffices. 

Delirium Tremens : 
Alcohol, 528, of great utility when assimilation 
can not proceed without it. Bromides, 598, 
may cure the preliminary "horrors," and suc- 
ceed in mild cases of delirium tremens. Chlo- 
ral, 568, very effective, but dangerous in old 
topers and cases of weak heart. Paraldehyde, 



538, Hypnone, 542, Urethan, 541, are safer 
and probably not less efficient. Pilocarpine, 
626, has proved highly useful. Chloroform, 
54S, by the stomach, lessens delirium and pro- 
cures sleep. Arnica Tincture, 620, highly 
serviceable when there is much depression 
Digitalis, 46S, tincture or infusion, especially 
the former, in full doses in cases with cardiac 
depression, anaemia of brain, due to low ten- 
sion and lessened vis-a-tergo. Opium, 586, 
must be given cautiously, and the attempt to 
overwhelm the brain avoided. Quinine, 196, 
to restore digestion and support the powers of 
life. Cannabis Indica, 510, sometimes is re- 
markably quieting. Carbonate of Ammonia, 
228, required in condition of depression. Cap- 
sicum, 730, has hypnotic effects of great value 
in mild cases. 

Dementia Paralytica : 
Paraldehyde, 538, as a calmative. Physostig- 
ma, 633, has seemed to retard the progress. 
Chloride of Gold and Sodium, 280. 

Diabetes : 
Aliment, 48, 60, all saccharine and starchy foods 
excluded. Buttermilk, 53. The Milk-Cure, 
46, has succeeded remarkably in some cases ; 
Buttermilk, 54, may be better. Alkalies, 207, 
and Alkaline Mineral- Waters, 205, of great 
value in the glycosuria of obese subjects. Ar- 
senic, 266, and Opium, 266. combined with ad- 
vantage in thin subjects. Arseniate of Sodium, 
164, with phosphate of soda and the Phos- 
pliates, 131, which are also useful of them- 
selves. Lactic Acid, 93, has sometimes done 
good. Oxygen, 342. Hydrogen Dioxide, 342. 
Salicylic Acid, 368. Opium, 533, especially 
codeine, restrains the waste of sugar. Gold 
and Sodium Chloride, 457, is a promising 
remedy. Saccharin, 387, as a sweetener of 
foods, and as an antiseptic. 

Diabetes Insipidus : 
Dry Diet, 47. Ergot, 417, is one of the most effi- 
cient remedies. Pilocarpus, 624, has done 
good in some cases. Valerian. 608, restrains 
the flow but does not cure. Muscarine, 671, 
has been used with apparent success. Auri et 
Sodii Chloridum, 2S0, has been of benefit 
when sclerosis is developing. Iodide of Potas- 
sium, 248, has cured cases of syphilitic origin. 

Diarrhoea : 

Chalk, 212, in the diarrhoea of children, mistura 
cretaz, with or without opium. Calomel, 270, 
in minute doses, or hydrarg. cum creta, when 
the stools are pasty and whitish. Bismuth, 
153, especially combined with creosote and gly- 
cerine, is useful, but large doses are necessary. 
Zinc Salts, 301, especially the Oxide, 301, 
which may be given with bismuth, or the sul- 
phate with morphine in the diarrhoea of adults. 
Sulphate of Copper, 291, is the most efficient 
of the mineral astringents in chronic diarrhoea ; 
is usually combined with opium. Arsenic, 161, 
Fowler's solution, with tincture of opium when 
undigested food is passed soon after meal, and 
in chronic diarrhoea. Mineral Acids, 106. es- 
pecially sulphuric, in profuse watery stools, or 



CLINICAL INDEX. 



783 



Hope's mixture. Acetate of Lead, 296, one of 
the most generally useful astringents. Cam- 
phor, 501, with or without opium, for summer 
diarrhoea. Ergot. 455, has proved very success- 
ful in some epidemics. The newer remedies, 
also highly efficient, are Salol, 379, and Xaph- 
thalin, 3S5, supposed to be decomposed by 
pancreatic solution and therefore acts locally 
by its released constituents. Tannic Acid, 
821, and vegetable astringents containing it, 
especially rubus, kino, catechu, are much em- 
ployed in simple diarrhoea. Aliment, 49, 51, 
52, and 5S, milk-cure, raw-meat pulp, but cau- 
tion is necessary in respect to the latter, be- 
cause of danger of taenia. 

Diphtheria : 
Belladonna, 482, useful at outset to check exu- 
dation, and later to support weak heart. Car- 
bolic Acid, 354, locally in solution and spray, 
and systemically. Chlorine, S44, aqua chlo- 
ri and chlorinated lime and soda topically to 
correct fetor and destroy germs. Hydrogen 
Dioxide, 343, and Pictet Liquid, 347. Lactic 
Acid. 101, one of the best solvents. Sulphurous 
Acid, 233, an antiseptic, in spray of dilute so- 
lution to fauces. Nitrate of Silver, 236, local 
application to fauces now but little used. Po- 
tassa Chlorate, 206, 212, 214, more largely 
used than any remedy, topically, and by the 
stomach. Iron, 140, tincture of the chloride 
much employed, undiluted to the fauces, and by 
the stomach in full doses; also largely pre- 
scribed with potassa chlonite. Muriatic Acid, 
105, was formerly applied to exudation. Sali- 
cylic Acid, 36S, and the salicylates, the former 
also locally, to reduce temperature and prevent 
systemic infection. Resorcin, 376. acts simi- 
larly to carbolic and salicylic acids. Alcohol, 
52S, very much prescribed for support, and to 
prevent diffusion of the poison. Eecently Pilo- 
carpus, 62S, has been brought forward as a 
remedy, but reports are conflicting. Euca- 
lyptus, 175, Ttirpentine, 723, and Tereoene, 
724, in vapor. Salol, 3S0, Xaphthol, 3S5, and 
other of the newer antiseptics are now used 
with varying success. 

Dropsy : 
Digitalis, 469, one of the foremost remedies, es- 
pecially in cardiac and renal dropsy, less so in 
dropsy of cavities. The " digitalis group " con- 
tains some of the most effective remedies, as 
Squill, 735, Caffeine, 518, Strophantus, 474, 
Adonidin, 476, and others. They have effects 
similar to digitalis, and are prescribed under 
the same conditions. Juniper, 733, Scopa- 
rius, 733, and its alkaloid, Sparteine, and 
other urino-genitals having diuretic properties, 
of great value in cardiac dropsy : must be used 
cautiously in renal dropsy. Copaiba, 726, es- 
pecially the resin, has given good results in 
ascites. Potassa Salts, 207, especially bitar- 
trate and acetate largely diluted, highly useful 
in renal dropsy. Iron, 143, especially tincture 
of the chloride, alone or in Bashanfs mixture, 
as a diuretic and to correct anaemia. Pilocar- 
pus, 624, very valuable in renal dropsy when 



secretion of urine is much reduced or sup- 
pressed, and when convulsions occur, ffydro- 
gogue Cathartics, 706, especially indicated in 
ascites. Saline Purgatives, 693, in general 
dropsy. Dry Diet, 47, Milk- Cure, 52. 

Dysentery, Acute : 
Aliment, 56, of first consequence. Saline Pur- 
gatives, 693, especially Epsom salts in acute 
dysentery, with bloody discharges and high 
fever. Ipecacuanha, 685, a remedy of highest 
value in acute, epidemic, and puerperal ; must 
be administered in large doses; milk a good 
vehicle. Nitrate of Silver, 285, Sulphate of 
Copper, 291, Sulphate of Zinc, 301, are excel- 
lent astringents after the more acute symptoms. 
Acetate of Lead. 296, may be used at any pe- 
riod, but better after action of salines, in acute 
disease. Opium, 582, combined with some of 
the astringents, but given after the action of 
salines in the acute disease. Turpentine. 720, 
in epidemic dysentery of low type. Ergot. 455, 
has been used with success in acute. One of 
the new antiseptics, NapMhalin, 385, has 
proved a valuable remedy in diarrhoea, and it 
also entirely deodorizes the stools. Salol, 378, 
is highly efficient in arresting intestinal fermen- 
tation. 

Dysentery, Chronic : 
Aliment, 52, 56, Grape-Cure, 48, Arsenic, 161— 
Fowlers solution with opium. Iron, 298, per- 
nitrate, a powerful astringent. Tannic Acid, 
321. with milk-diet, and the vegetable astrin- 
gents. Silver, copper, and zinc salts (as above), 
with opium. Nu<x Vomica, 438. Ergot. 455. 
Ipecac, 683, and especially the antiseptics 
Naphthalin, 385, and Salol, 379. 

Dysmenorrhea : 
Aconite, 653, and Pulsatilla, 665, for the con- 
gestive form especially succeeding to suppres- 
sion. Ergot, 455, under the same conditions 
as the two preceding; also, Cimicifuga, 478. 
Camphor, 501, Gelsemium. 618, and Apiol, 
736. are useful in the Eeuralgic form. Amyl 
Nitrite, 649, affords relief quickly. Chloro- 
form, 54S, Chloral, 569. Cannabis Indica, 
511, Morphine, 587, especially with Atropine, 
591, all give relief in painful menstruation. 
When menorrhagia coexists, or there is pleth- 
ora, Sodium Bromide, 603. Electricity, 427, 
galvanism during the interval is highly useful. 
Iron, 143, in anaemic cases. 

Dyspepsia : 
Diet, 52, 53, 5S, the most important, especially the 
milk-cure. Pepsin, 99, Ingluvin, 99, and Pan- 
creatin, 99, assist digestion in atonic dyspepsia. 
Mineral Acids, 106, muriatic acid after meals, 
with or without pepsin, in atonic dyspepsia. In 
case of an excess of acid of stomach -juice, the 
mineral acid before meals. In excess of uric 
acid as well as of stomach aoid. Nitric Acid, 
106, is the most efficient. Alkalies, 206, to re- 
lieve excess of acid; given before meals, alka- 
lies favor the production of acid gastric juice ; 
after meals, neutralize acid. Alkaline Miner- 
al-Waters, 21S, 219, as well as alkalies, are 
highly useful in dyspepsia of obese subjects. 



'84 



CLIXIC1L INDEX. 



Antiseptics, 84$. et seq., should be used when 
acid fermentation occurs. Bitters, Simple, 169, 
especially gentian and calumba, stimulate diges- 
tion ; may be given with acids or alkalies. Ar- 
senic, 160, drop doses of Fowler's solution, re- 
lieve irritative dyspepsia. Silver, 284, oxide 
especially, is very useful. Nux Vomica, 438, 
is an excellent stomachic tonic, and removes 
various nervous symptoms. Hydrastis, 1T9, 
Eucalyptus. 1T5, Wild Cherry, 169, Hop, 592, 
are useful stomachic tonics. 

Ear- Ache : 

Opium, 590, in the form of morphine solution, 
which is usefully combined with atropine. Co- 
caine, 5 to 10 per cent solution, the most effect- 
ive remedy, 515. Heat, 85. 

Eclampsia : 

Transfusion, 24, has been successfully employed 
in ursemic convulsions. Bloodletting, 754, 
when there is much cerebral congestion. Mor- 
phine, 586, hypodermatically in ursemic. Chlo- 
roform, 557, by inhalation. Chloral, 568. Bro- 
mide of Potassium, 600. Pilocarpine, 626, in 
urnsmic or puerperal convulsions. Veratrum 
Viride, 668, in puerperal. 

Ecthyma : 

Cod-liver Oil, 117, both internally and locally. 
Quinine, 197, usually effects a cure, but must 
be given in full doses. Carbonate of Lead, 
298, Solutions of the Acetate, 298, Naphthol 
and Naphthalin, 385, Iodoform, 251, and Iodol, 
260, are the most useful topical applications. 

Eczema : 

Carbolic Acid, 356, internally and externally. 
Salicylic Acid, 372, applied locally. Boracic 
Acid, 388, one of the most efficient remedies, 
locally. Lead, 298, liquor plumbi subacetatis 
with glycerin, a good application when there is 
abundant secretion ; also lead-paint— carbonate 
with linseed-oil — spread on thickly. Bismuth, 
subnitrate, 153, and salicylate, 372, in powder 
freely to the eruption. Tannin, 324. in powder 
dusted over, or as glycerite of tannin; also, 
Pyrogallic Acid, 326, with caution. Copper 
Sulphate, 292, Zinc Sulphate, 302, Silver Ni- 
trate, 288, are useful astringent applications. 
Mercury, 277, the brown citrine ointment to 
eczema of eyelids. Belladonna, 487, or atro- 
pine, internally, is beneficial in the acute cases. 
Arsenic, 1 62, is curative in chronic cases ; when 
the skin is much thickened by exudation in the 
chronic cases, Jequirety. 752. Electricity, 427, 
by central galvanization has done great good in 
chronic cases. An exclusive milk-diet, 52. 

Emphysema : 

Compressed Air, 92, affords much relief, some- 
times permanent. Oxygen, 342. Oxygen Hi- 
oxide {Ozone), 343, for the paroxysms of diffi- 
cult breathing. Grindelia, 666, gives great 
relief to the oppression. Arsenic, 161, long 
continued, improves the nutrition of the lungs. 
Iodides, 247, Iodoform, 258, Ethyl Iodide, 
253, by inhalation act both by contact and by 
absorption. Cod-liver Oil. 116, improves the 
condition, Hypophosphites. 131. also. Strych- 
nine, 441, ia a valuable respiratory stimulant, 



For the element of spasm. Pyridine, 3S6, Tere- 
bene, 723, and others. 
Empyema : 
Iodine, 252, a solution of iodine and iodide of po- 
tassium to wash out the cavity and prevent re- 
accumulation of pus. Carbolic Acid, 356, 
and Carbolate of Iodine, 359, to correct fetor. 

ENDOCABDITI8 : 

Quinine, 190, to check inflammation. Chloral, 
567, unless heart is weak, when it becomes 
dangerous. Salicylic Acid, 371. is useful in 
the rheumatic form of the disease; also, Salol, 
380. Morphine, 586. as a remedy in serous in- 
flammations. Potash Salts, 206, liquefy exu- 
dation. 

Endometritis : 
Carbolic Acid, 356, undiluted on cotton-wrapped 
probe. Iodo-tannin, 252, and iodoform and 
tannin locally. Chromic Acid, 757. applied in 
solution to interior of cavity. Nitric Acid 
(fuming), 111, highly efficient, but requires 
caution. 

Estteralgia : 
Milk- Cure, 52, stops the troubles of digestion 
which give rise to the pain. Fermentable foods 
to be avoided— starch and sugar, 59. Arsenic, 
160, is remarkably beneficial in the more strictly 
neuralgic cases. Belladonna. 4S2. is useful as 
an anodyne, atropine especially. Prussic Acid, 
642 (official solution), gives relief promptly, or 
fails entirely. Galvanisation, 426. central, per- 
sistently applied, is curative sometimes. 

Enteritis. (See Diarehcea, Dyse>-teey.) 
Diet, 52, 56. must be regulated, an essential point 
in treatment. Arsenic, 160, with opium, usu- 
ally highly effective as a remedy. Copper Sul- 
phate, 291, Lead Acetate, 296, and the other 
mineral astringents, with opium, are curative. 

Epilepsy : 
Amyl Nitrite, 648, inhaled when aura is felt may 
prevent seizure: Nitro- glycerin, 652, also, if 
there be more time. Bromide of Potassium, 
600, is the most useful remedy, but is adapted 
to the cases occurring in the daytime, to the 
grand mal, and to reflex epilepsy, and to the 
condition of cerebral hyperemia rather than 
anaemia. Chloral, 568, is the most suitable 
remedy for the nocturnal variety. Cannabis 
Indica and Cannabinum Tannicum, 510, 
Atropine, 485, Strychnine, 440, Picrotoxin, 
447, are suitable for petit mal. for nocturnal 
variety, for cases characterized by anaemia and 
depression, and must be faithfully persisted in 
for a long time. The last-named seems most 
promising. Silver Nitrate. 2S5. formerly much 
prescribed, and not without utility, but the 
danger of staining is great. Salts of Copper, 
292, especially Cuprum Ammoniatum, Zinc 
Oxide. 302, so called nervine tonics, have been 
beneficial, but are not curative. Iron, 141, 
especially the bromide, with potassium bromide 
to prevent the anaemia and depression caused 
by the latter. 

Epistaxis : 
Ergot, 456, Barium Chloride. 231. Digitalis, 465, 
Ipecacuanha, 684, restrain haemorrhage by act- 



CLINICAL INDEX. 



785 



ing on the vessels. Turpentine, 721, in oozing 
from relaxation. Locally Tannin, 823, in solu- 
tion injected. Iron, 137, subsulphate in spray, 
or weak solution applied by irrigation. Alum, 
315, powder insufflated, or solution injected. 
Transfusion, 24, when a fatal result is threat- 
ened from loss of blood. Intravenous injection 
of Ammonia when heart fails, 21. Subcu- 
taneous injection of Ether, 545. 

Epithelioma : 

Coptis, 169, infusion or decoction locally, espe- 
cially in epithelioma of the tongue. Potassium 
Chlorate, 214, recently ascertained to be very 
effectual applied in powder. Zinc Chloride, 
and Sulphate dried, 302, useful escharotics. 
Carbolic Acid, 356, injected beneath tumor. 
Salicylic Acid, 372, and Boracic Acid, 3S3. 

Erysipelas : 
Aconite, 658, in the idiopathic variety, when 
there is much fever. Belladonna, 485, a very 
beneficial remedy, combined with aconite when 
there is sthenic reaction. Quinine, 197, in full 
doses in the more severe cases, to sustain the 
powers of life and prevent cerebral embolism. 
Salicylic Acid and Salicylates, 363, Benzoate 
of Sodium, 391, Besorcin, 376, and Salol, 380, 
to prevent systemic infection in traumatic va- 
riety. Carbonate of Ammonia, 226, when 
cardiac depression exists. Iron, 140, especially 
tincture of the chloride in large doses. Locally 
ArgenU Nitras, 288, according to Higgin- 
botham's method, Carbolic Acid, 353, Tri- 
chlorphenol, 360, and the antiseptics generally 
to the inflamed area. Oil inunctions are very 
grateful in simple erysipelas, 115. 

Erythema : 

Quinine, 197, is very effective in erythema no- 
dosum ; Belladonna in the simple form, 287. 
Zinc, 303, Alum. 316, and Lead, 298, are suit- 
able local applications, as lotions. Bismuth 
dusted over the surface allays irritation, 154. 
"When the disease is reflex from gastrointesti- 
nal disorder, Nitric, 110, and Muriatic Acids, 
110, are beneficial. 

Exophthalmic Goitre : 
Iron, 140, and Chalybeate Waters, 151, for the 
anaemia. Digitalis, 466, Barium, 231, Ergot, 
456, and in some cases Belladonna, 447, raise 
the arterial tension and slow the heart. Gal- 
vanism, 426, in uncomplicated cases, is decid- 
edly curative. 

Favtts : 

Cod-liver Oil, 117, locally, and in case of debility, 
by the stomach. Carbolic Acid, 356, an effi- 
cient parasiticide. Naphthol, 385, still more 
useful. Myrtol, 396, Besorcin. 376, Salicylic 
Acid, 372, and Boracic Acid, 388, are efficient 
local applications. 

Feet, Fetor of : 
Potassa Permanganate, 147, in solution, will re- 
move fetor temporarily. Bicarbonate of Soda, 
214, a saturated solution, is serviceable. Sal- 
icylic Acid, 371. in powder freely dusted over 
the feet and stockings, is very effective. Ben- 
zoin tincture, 390, when "frost-bite" is the 
cause, but useful in all. 
51 



Felon : 
Nitrate of Silver, 2S7, a strong solution in nitric 
ether applied over the part may abort the 
affection, if at the beginning. Nitrate of Lead, 
298. 

Fever : 
Aconite, 65S, highly useful in simple inflamma- 
tion, and in the eruptive fevers. Aliment, 56, 
62, must be regulated. Alcohol, 528, does good 
when the temperature declines, the pulse falls, 
the skin perspires, and the tongue grows moist. 
Baths, Cold, 75, certain method of reducing 
body-heat, and especially valuable in typhoid 
and pneumonia. Digitalis, 466, is indicated in 
inflammatory fever and in the eruptive fevers 
during the first stage, and as an aid to quinine 
when employed as an antipyretic. Quinine, 
190, occupies the first position as an antipyretic, 
and is more generally applicable than any other. 
Chloral, 567, reduces fever and is highly use- 
ful when high febrile excitement coincides with 
delirium and wakefulness. Salicylic Acid, 
367, Besorcin, 376, Benzoate of Sodium, 390, 
are antipyretic and antiseptic. Among the 
newer contributions to the antipyretics, and 
most effective, are Antipyrine, 382, Acetani- 
lide, 394, Salol, 380. Calomel, 273, and com- 
pound solution of Iodine, 249, the former ad- 
ministered during the first week, and the latter 
during the whole course of typhoid fever, affect 
the course and duration favorably; "the spe- 
cific treatment'" of the Germans. Carbolic 
Acid, 354, and Carbolate of Iodine, 353, have 
good effects in typhoid. Turpentine, 721. in 
typhoid, puerperal, and yellow fever, when 
there is much vaso-motor depression, haemor- 
rhage, etc. 

Fi8sitre op the Antjs: 
Hydrastis, 180, the fluid extract applied undi- 
luted. Iodoform, 252, dusted well over the 
fissure, and Iodo-tannin, 252, applied in the 
same way. Trichlor phenol, 360. Carbolic 
Acid, 356. Cocaine, to allay irritability, 515. 

Fissure of Nipples: 
Iron, 144, liquor ferri subsulph., and glycerin ap- 
plied with a brush. Tannin, 823, in powder or 
the glycerite. Tincture of Benzoin, 390, with 
glycerin. Brandy, 530, with or without gly- 
cerin. Collodion, 759, flexile collodion, or Liq. 
Guttce Percho3, 759, applied to close fissure. 
Nitrate of Lead, 298, with simple ointment or 
glycerin, is the most efficient application. 

Flatulence : 

Calumba, 170, with aromatics. Camphor, 501, 
will often give prompt relief. Chloroform, 547, 
especially the spirit. Asafoetida, 505, Yale- 
Han, 507, and Spirit of Ether, 544, compound,, 
are adapted to nervous and hypochondriacal 
cases. Turpentine, 720, is indicated in the 
flatulence of fevers, peritonitis, etc. Nux 
Vomica, 438, Belladonna, 482, Physostigma, 
632, and probably Muscarine, 672, give relief 
to those cases of flatulence dependent on pare- 
sis of the muscular layer of the bowel. Diet 
is of the highest importance, in cases arising 
from intestinal indigestion. 



786 



CLINICAL INDEX. 



Freckles : 
Alkalies, 213, in form of a lotion composed of 
potassa carbonate and chloride of soda. Bibo- 
rate of Soda, 3SS. a saturated solution, is a safe 
and often successful lotion. Naphthol, 3S5, 
Boracic Acid, 3SS, and Tincture of Benzoin, 
390, are newer and efficient remedies, 

Gall-Stones. (See Calculi, Biliaby.) 

Gangrene : 
Bromine, 346, one of the best escharotics in hos- 
pital gangrene to arrest morbid action. Chlo- 
rine^ 345. Chromic Acid, 756, is a highly- 
efficient caustic, and penetrates deeply with 
little pain, comparatively. Chloride and 
dried Sulphate of Zinc, 302, powerful, but 
painful. Potassa Fusa, 214, an active escha- 
rotic. Nitric Acid, 110, next to bromine, is 
the most useful caustic to arrest the destruction 
of parts, external, by gangrene. The Anti- 
septics applied to the affected surface, includ- 
ing Carbolic Acid, 356, Salicylic Acid, 372 
Besorcin, 376, Salol, 378, Iodoform, 251, 
Myrtol and Thymol, 396, and others, are the 
most effective now used. To these Cam- 
phor, 502, may be added. Turpentine, 723, 
internally and by vapor • inhaled, and Euca- 
lyptol, 176, are highly useful in gangrene of 
the lungs to prevent extension and to destroy 
fetor. 

Gastralgia : 
Aquapuncture, 750, injections under the skin of 
water over the epigastrium, affords much relief. 
Alum, 314, is useful in the cases with acidity 
and pyrosis. Arsenic, 160, one or two drops t. 
d. of Fowler's solution, is the most generally 
effective of all remedies. Ether, 544, Chloro- 
form, 547, Atropine, 482, and the anodynes, 
allay the pain. Bismuth, 152, and with Cre- 
osote and Glycerin, 353. Oxides of Zinc, 
301, of Silver, 284, and of Manganese (puri- 
fied), 146, make a permanent impression on the 
nerve-endings in the mucous membrane, and 
hence give permanent results. Hydrocyanic 
Acid, 643, and Cyanide Potass^ 645, if success- 
ful, are speedily so. Nitro-glycerin, 652, also 
acts quickly and often effectively. In cases 
having a distinct periodicity, Quinine, 195, and 
Salicylic Acid, 367, have acted well, and Bes- 
orcin, 376, will probably be found beneficial. 
Nux Vomica, 437, may remove the morbid 
state on which the pain depends. Morphine, 
5S7, subcutaneously, alone or combined with 
atropine, stops the pain at once. Galvanism, 
426, the pneumogastric and sympathetic acted 
on, has been successful. Diet, 5S, is of the ut- 
most consequence. 

Gastric Catarrh : 
Aliment, 58, especially the milk-cure. Arsenic, 
160, is the most important remedy ; next are 
Oxides of Silver, 284, Manganese, 146, and 
Zinc, 301, Bismuth, 152, Alum, 314, and Ace- 
tate of Lead, 296. The Bitters, 168, especially 
Cahimba, 168, Nux- Vomica Tincture, 437, 
Cinchona Infusion, Eucalyptus, 175, and 
Hydrastis, 179, are beneficial, if not continued 
too long. To these may be added the various 



Antiseptics, as Creosote, 853 etseq., and others 
of same group. 

Gastric Ulcer: 
Milk-Cure, 52, 58. Rectal Alimentation, 63. 
Nutrient Enemata, 62. Acetate of Lead, 296, 
sedative and arrests haemorrhage. Bismuth, 
152, allays pain and arrests vomiting. Arsenic, 
160; Fowler's solution in drop-doses also less- 
ens pain and vomiting remarkably. Silver Ox- 
ide and Nitrate, 254, promote cicatrization and 
relieve pain. Morphine and Atropine, 590, 
587, arrest pain and vomiting, even in very 
minute quantity. 

Gastritis, Acute : 
Ice, 74, Hydrocyanic Acid, 644, Morphine, 582, 
subcutaneously or endermically. Creosote, 
353. Rectal Alimentation, 62. 

Gastritis, Chronic. (The same as for Gastric 
Catarrh.) 

Glands, Lymphatic, Affections of. 
Carbolic Acid, 356, properly diluted, injected 
into the substance of glands; also Iodine, 251, 
and Iodoform, 258, solutions. Iodides of Iron 
and Manganese, 139, 146, internally, and tinct- 
ure of iodine injected into the substance of 
glands, 248. Sulphides, 237, are said to mature 
or abort suppuration in glands. Chloride of 
Calcium, '212, and. Phosphates, 130, are highly 
useful in strumous inflammation and suppura- 
tion. Pilocarpus, 625, 629, has a curative ac- 
tion in acute affections of parotid and submax- 
illary glands. Conium, 607, locally and sys- 
temically, has long been regarded as discu- 
tient. Mercury, 273, especially bichloride, in 
acute inflammatory diseases of tonsils, parotid 
and submaxillary glands. Iodide of Lead, 25S, 
and Iodoform, 259, as an ointment externally. 
Ointment of the Red Iodide of Mercury, 277, 
has remarkable effects in goitre, enlarged 
spleen, etc. 

Gleet : 
Iron, 143, tinct. ferri chloridi, in anaemic sub- 
jects. Turpentine, 723, is beneficial when the 
local condition is one of relaxation. Juniper, 
731, Cantharides Tinct., 740, are useful under 
the same circumstances. Iodoform, 251, and 
Iodol, 260, in pencils. Blisters, 74S, to the 
perinaeum are very beneficial. 

Goitre : 
Iodine, 251, both internally and locally, effective 
in the case of simple hypertrophy. Ointment 
of the Red Iodide of Mercury, 277, exception- 
ally useful in same state. Injections of Tinct- 
ure of Iodine, 139, 24S, very effective in cystic 
degeneration. Electrolysis, 42S. has succeeded 
in simple hypertrophy and cystic state of gland. 

Gonorrhoea: 
Internal Eemedies.— Copaiba, 726, Cubeb, 728, 
Buchu, 733, and other urino-genital remedies, 
more useful after acute symptoms. Colchicum, 
330, Saline Laxatives, 692, Aconite, 65S. and 
Veratrum Viride, 662, during the first acute 
symptoms, Turpentine, 723, and Cantharides 
Tincture, 740, for the chronic stage. 
Injections.— Bismuth, 154, with or without Fl. 
Ex. of Hydrastis, ISO, is one of the best. Zinc 



CLINICAL INDEX. 



787 



Sulphate, 303, a very weak solution, often re- 
peated, can be used alone, or chloride or sul- 
phate of zinc and Acetate of Lead, 298, in 
combination. After the acute symptoms, 
stronger solutions and pencils of above and 
MtraU of Silver, 288, Sulphate of Copper, 
292, Subsulphate of Iron, 144, Cadmium Sul- 
phate, 309, Alum, 316, and Tannin, 323. 

Gout: 
Aliment, 60, of first importance. Alkalies, 206, 
and Alkaline Mineral- Waters, 218, especially 
potash and lithium salts. Manganese Salts, 
146, very serviceable in chronic gouty affections. 
Salicylic Acid, the salicylates, and Salol, 380, 
very effective in the acute form. Guaiac, 333, 
after acute symptoms. Colchicum, 329, espe- 
cially colchicine, the most celebrated remedy 
for the paroxysms. Arnica, 620, and Trime- 
fhylamine, 621. Arsenic, 163. Sulphurous 
Waters, 241. Sulphur-Baths, 238. 

Gums, Affections of : 
Alum, 316, for spongy and bleeding. Tannin, 
323, especially Glycerite, 323, for same condi- 
tion. Carbolic Acid, 356, and Iodoform, 258, 
when fetor is present. Benzoin Tincture, 390, 
with or without glycerin. Resorcin, 3T6. 

HaEMATEMESIS : 

Alum, 316, especially in passive. Acetate of 
Lead, 297, may be used in all conditions. Iron, 
137, as Monsel's solution, one of the most effect- 
ive applications. Tannin, 323, and the vege- 
table astringents, especially Hamamelis, 321, 
Rhatany, 321, and Logwood, 321, Turpentine, 
721, in weak and relaxed state of vessels. Er- 
gotin, 456, subcutaneously. 
Hematuria: 

Ergot, 456, by the stomach or subcutaneously ; 
may be combined with rhatany, ipecacuanha, or 
other astringents. Gallic Acid, 321, one of the 
most useful remedies. Rhatany, 321, owes 
its utility to the presence of tannic and gallic 
acids. Quinine, 196, is highly effective in the 
intermittent or malarial form; Turpentine, 
718, in the hsemorrhagic diathesis, and in the 
passive form. 
Haemoptysis : 

Ergot, 456, with ipecac and a little opium by the 
stomach; ergotin subcutaneously. Gallic Acid 
and ergot, 821, by the stomach. Ipecacuanha, 
684. Digitalis, 465. Tinct. of Verat. Viride, 
662. Barium Chloride, 231. Iron, 142, sub- 
sulphate solution in spray, a highly effective 
application. Acetate of Lead, 296, with opium, 
frequently prescribed, but not so effective as 
those previously named. 

HAEMORRHAGE AND HEMORRHAGIC DlATHESTSt 

Arterial Sedatives.— Digitalis, 463. Verat. Vi- 
ride, 662, Aconite, 656, Acetate of Lead, 296, 
Barium Chloride, 231, Venesection, 754, Ipe- 
cac, 684, and Ergot, 456, act by slowing the 
heart and diminishing the caliber of the vessels, 
and are therefore adapted to active hasmorrhage. 
Turpentine, 718, Ammonia, 236, by stomach 
and by intravenous injection, and Alcohol, 528, 
relieve, by increasing the contractile energy of 
the vessels, and are therefore indicated in pas- 



sive hasmorrhage. To these must be added 
Transfusion, 24, when death is imminent from 
simple loss of blood. Astringents are em- 
ployed locally and systemically, and include 
Alum, 315, Acetate of Lead, 297, Iron, Sub- 
sulphate and Chloride, 137, 142, 144, Sulphuric 
Acid, 109, Tannin, 321, Gallic Acid, 321, and 
the Vegetable Astringents, 320, 322. 

HAEMORRHAGE, CEREBRAL : 

Venesection or Leeches, 754, when the blood- 
pressure is high and hasmorrhage threatened or 
proceeding. Purgatives, 692, under the same 
circumstances. Ergotin, 456, Barium Chlo- 
ride, 231, and arterial sedatives, when collateral 
hyperemia comes on. 

HAEMORRHAGE, INTESTINAL . 

Tannic Acid, 321, and vegetable astringents. 
Acetate of Lead, 297. Sulphuric Acid, dilute, 
109. Iron, pernitrate, 137. Turpentine, 718. 
Opium, 583, to quiet intestinal movements. 
Ice, 80, to abdomen. Ergotin, 456, hypoder- 
matically. 

Haemorrhage, Uterine : 
Ergot, 456, fluid extract in full doses. Ipecac, 
684, carried to nausea merely, is highly effective. 
Digitalis, 465, Barium Chloride, 231, Sul- 
phuric Acid, dilute, 109, small doses frequently, 
and Epsom Salts, 692. Cold, 85. Rot Water, 
85. Iron, 144; Monsel's solution, diluted, in- 
jected. 

Haemorrhoids : 
Aloes, 700, in recent haemorrhoids, as after de- 
livery, highly useful. Ergot, 451, in dilated 
hemorrhoidal veins without new tissue, by the 
stomach and topically. Alkaline, 218, Sulphu- 
rous, 222, and purgative Chalybeate Waters, 
especially Bedford, 150. Saline Purgatives, 
692, notably Epsom salts, in bleeding piles. Sen- 
na, 696, the confection especially, Sulphur, 687, 
and Cream of Tartar, 693, to render move- 
ments soft and easy ; also, Cascara Sagrada, 
6S9, and Pulv. Glycyrrhiz. Comp., 687. The 
Grape-Cure, 48. Alum, 316. Iron, 144 ; Mon- 
gers solution to arrest bleeding. Leeches, 756, to 
inflamed piles. Nitric Acid, 110, to the mul- 
berry, bleeding pile. Ting. Galloz, 323. oint- 
ment for haemorrhoids. The parenchymatous 
injection of Carbolic Acid, 355, the first of all 
remedial measures. 

Hay- Fever : 
Arsenic, 161, internally and in cigarettes. Atro- 
pine, 483, when secretion is profuse. Carbolic 
Acid, 353, by inhalation. Bromine, if cautious- 
ly used, highly efficient, 345. Quinine, 196, 
199, is useful at onset in spray, locally, and later 
as a tonic. Iodides, 246, carried to iodism, af- 
ford great relief; may be combined with arsenic. 
Also Ethyl iodide, 254, Pyridine, 386, and 
others, by inhalation. Grindelia, 667, for the 
asthmatic symptoms. Muscarine, 670, will 
probably prove useful in the asthmatic stage, if 
membrane is dry. Morphine, 58S, is probably 
beneficial at any stage, but great danger of mor- 
phine-habit. Pilocarpine, 624. Nitro-glycer- 
in, 652, for the asthma. Cocaine, to the nose, 
515, most effective of present remedies. 



788 



CLINICAL INDEX. 



Headache : 
Ammonia, 226, for nervous headache; especially 
aromatic spirits. Arsenic, 162, for cerebral 
congestion and hemicrania. Bromides, 599, 
for true migraine. Digitaline, 468, in con- 
gestive hemicrania, from venous hyperemia. 
Ergot, 456, in the headache of miliary aneu- 
risms and in arterial hyperemia. Galvanism, 
421, applications to cervical sympathetic during 
intervals, persistently, and mild transverse ap- 
plications during seizure. Nitrite of Amyl, 
648, by inhalation in cases characterized by 
vaso-motor spasm (pallor of face). Also Nitro- 
glycerin, 652, internally under same condi- 
tions. Potassium Cyanide, 646, a solution 
applied on compress to painful region. Phos- 
phate of Soda, 130, in headache due to "bil- 
iousness." Picrotoxin, 447, in neuralgic head- 
ache ; also Strychnine, 440. 

Heaet, Diseases of : 
Aconite, 657, Yeratrum Viride, 661, and Bro- 
mides, 599, for overaclion and simple hyper- 
trophy. Digitalis, 468, in rapid action with 
low tension and valvular lesions. Cimicifuga, 
478, under the same conditions. Ergot, 450, is 
useful in dilated heart. Amyl Nitrite, 649, in 
angina pectoris ; also Nitro - glycerin, 653. 
Iron, 142, remarkably beneficial in the irritable 
heart of anaemia. Morphine, 5S3, hypoder- 
matically in dilated heart and general dropsy 
therefrom. Quinine, 190, in peri- and endo- 
carditis and cardiac weakness. Ammonia, 226, 
inhaled, intravenous, and by the stomach in 
sudden failure. Atropine, 483, a prompt car- 
diac excitant. 

Hemiplegia: 

Galvanism, 422, cautiously applied to the brain ; 
faradism to the muscles, if they waste or de- 
generate. Strychnine, 439, 442, hypodermati- 
cally into the paralyzed muscles, after local 
troubles have ceased. Massage, 94. 

Hepatic Diseases : 
Aconite, 656, in acute inflammation. Alkaline 
Mineral Waters, 218 ; also Sulphurous, 237, 
in portal congestion. Colchicum, 329, is an 
active remedy in congestion of the liver. 
Nitro- Muriatic Acid, 106, and the acid-bath, 
are useful in torpor of liver. The resin-bearing 
purgatives, Rhubarb, 697, and the following: 
Aloes, 699, Podophyllum, 704, Euonymin, 702, 
and especially Ipecacuanha, 683, the most 
effective. Chloride of Ammonium, 226. and 
Iodides. 246, including Iodoform, 259, are use- 
ful in catarrh of bile-ducts. Salol, 379, and 
Salicylic Acid, 371, have decided effects. 
Phosphate of Sodium, 130, 210, one of the 
most certain and useful cholagogues. Chlo- 
ride of Gold and Sodium, 2S0, is effective in 
sclerosis. Mercurials, 271, have questionable 
utility. Phosphorus, 124, prevents the forma- 
tion or checks the growth of connective tissue 
(sclerosis). 

Heepes: 
Acetate of Copper, 292, as an ointment: Calo- 
mel, 277, also as an ointment, and Zinc Oint- 
ment, 303, are curative. Belladonna or Atro- 



pine, 487, internally, is useful. The Antisep- 
tics applied locally, 359, 360, 376, 380. Gal- 
vanism, 427, in cases having a neurotic origin, 
as II. zoster. 

HOABSENESS : 

Nitric Acid, 109, is highly effective in hoarseness 
of singers and reflex from stomach troubles. 
Atropine, 487, affords prompt relief usually in 
hysterical aphonia. 

Htdbocele : 

Carbolic Acid, 356, injected into the sac after 
the withdrawal of the fluid. Iodine Tinct- 
ure, 252, injected in the same way. Nitrate 
of Silver, 28S, a sufficiently strong solution 
thrown into the sac after fluid is removed. 
Galvano-puncture, 430, sometimes succeeds 
admirably. 

Hydeophobia : 
Amyl Nitrite, 649, by inhalation, and Nitro- 
glycerin, 652, by the stomach, should be faith- 
fully tried. Curara, 614, has apparently suc- 
ceeded. Morphine, 537, Paraldehyde, 53S, 
Methyl Chloride, 539, Hypnone, 542, Ethyl 
Bromide, 559, are palliative, and may have 
curative effects. 

Hydeothoeax : 
Iodine Injections, 252, to prevent reaccumula- 
tion of fluid. Pilocarpus, 624, to cause ab- 
sorption. Resin of Copaiba, 726, as a diuretic. 
Dry diet, 43. 

Hypocuondbia : 
Arsenic, 1 62, has good effects in the hypochon- 
dria of the aged. Colchicum, 329, with colo- 
cynth, to deplete the portal circulation. Caf- 
feine, 518, is a serviceable cerebral stimulant in 
these cases. Asafoetida, £05, is particularly 
indicated and has great value in cases charac- 
terized by much flatulence. Opium, 5S7 ; in 
some cases small doses of the tincture is a 
remedy of the first importance. Chloral, 56T, 
may be required to procure sleep. Chloride of 
Gold and Sodium, 2S0, gives excellent results 
in the hypochondria of the aged. 

Hysteeia : 
Ammonia, 226, the aromatic spirits, for the hys- 
terical seizure. Asafoetida, 505, Valerian, 
508, Camphor, 502, Eucalyptus, 176, Ether, 
544, are useful remedies to relieve the vapors 
and accompanying symptoms. Phosphates, 
130. Iron, 138, Coca, 515, Cod-liver Oil, 114, 
and the " rest-cure," 94. 95, are the remedies to 
relieve the abnormal mobility of the nervous 
system. 

Impetigo: 
Glycerite of Tannin, 323, an excellent applica- 
tion. Acetate of Lead, 293, in solution. Zinc 
Oxide. 303, dusted over or ointment applied. 
Quinine. 197. usually improves. The Mineral 
Acids, 110, in intestinal indigestion. 

Impotence : 
Phosphorus, or Phosphide of Zinc, 126, 130, are 
efficient stimulants. Cannabis Indica. 511, 
also stimulates the function. Nux Vomica, 
440, Sanguinaria, 337, also increase sexual 
activity, but differ in degree. Ergotin, 460, 
subcutaneously about the dorsal vein of the 



CLINICAL INDEX. 



789 



penis, or Fluid Extract of Ergot, 457, by the 
stomach, increase the vigor of the erections. 
Arseniate of Iron, 164, acts as a tonic to the 
organs. Chloride of Gold and Sodium, 280, 
has also slowly acting aphrodisiac effects. 

Incontinence, Nocturnal: 
Belladonna or Atropine, 480, carried to the point 
of inducing some physiological action. Ergot, 
459, in cases due to paresis of the muscular lay- 
er of the bladder. Iron, 142, sirup of the iodide, 
in weak, anaemic subjects. 

Indigestion : 
Aliment, 52, 56. In stomach indigestion, give 
foods digested chiefly in intestine, and, in intes- 
tinal indigestion, food digested chiefly in stom- 
ach. Milk-Cure, 52. Pepsin, Pancreatin, 
Ingluvin, digestive ferments, 99, increase ac- 
tivity and thoroughness of digestion. Mineral 
Acids, 106, and Lactic Acid, 102, in atonic 
dyspepsia and indigestion. Alkalies, 206, and 
Alkaline Mineral- Waters, 216, 219, for the in- 
digestion of the obese, gouty, and rheumatic. 
Sulphurous Acid, 235, for indigestion with 
pasty vomiting, sarcina, etc. Bismuth, 152, 
for painful indigestion and nausea ; also Hy- 
drocyanic Acid, 544. Strychnine, 438, or tinct. 
nucis vom., to stimulate organs; also Ignatia, 
444, and Picrotoxin, 44T. Aloes, 699, in indi- 
gestion with torpor of large intestine, and 
pasty motions. Alcohol, 528, an excellent 
stomachic tonic in moderate quantity for the 
indigestion of the old. 

Inflammation: 
Aliment, 58. Water, 79, the methods of hydro- 
therapy, to reduce heat. Alcohol, 529, in con- 
dition of systemic and cardiac depression, as an 
antipyretic, etc. Leeches, 755, very useful in cer- 
tain local inflammations superficially situated, 
the systemic condition being sthenic. Aconite, 
656, useful in inflammation of respiratory organs 
and parenchymatous inflammations in general. 
Veratrum Viride, 662, Gelsemium, 617, Ar- 
nica, 619, and especially Digitalis, 466, are 
valuable as arterial sedatives to diminish blood- 
supply to inflamed area, and cease to be benefi- 
cial when exudations begin. Belladonna, 483, 
in some catarrhal inflammations is highly use- 
ful. Alkalies, 208, especially the potash salts 
and ammonia, are very valuable in the exuda- 
tion stage. Saline Cathartics, 692, to lower 
the blood-pressure and to cause excretion of 
products of waste. To the remedies acting on 
the circulation may be added Barium Chloride, 
' 231, and Muscarine, 671, and under some cir- 
cumstances Ergot, 455. Quinine, 190, in full 
quantity, especially when combined with opium, 
may abort an incipient inflammation. Opium, 
581, is the most important remedy in serous 
inflammation. Tartar Emetic, 307, affords 
undoubted good results in some forms, notably 
in acute bronchitis. Pilocarpus. 626, has very 
satisfactory results in exudation in the eye, 
pleura, etc. 

Insolation. (Sunstroke .) 

Cold Bath, 73, or douche or wet pack, for the 
state of high fever. Morphine, 5S1, hypoder- 



matically. Turpentine Enema, 711, as a de- 
rivative. Brandy, 477, and Ammonia, 226, for 
heat-exhaustion. 
Insomnia : 

Alcohol, 529, 535, 536, in the condition of cerebral 
anaemia, or in quantity to induce narcosis. Par- 
aldehyde, 538, TJrethan, 541, Hypnone, 541, 
new and useful hypnotics. Chloral, 568, the 
most direct and generally useful hypnotic. Bel- 
ladonna, 485, in some morbid states with great 
restlessness and delirium ; but Hyoscyamine, 
494, Hyoscine, 496, and Duboisine, 498, in suf- 
ficient quantity, are more frequently successful, 
especially in the insomnia of mania, puerperal 
mania, etc. Bromides, 601. a direct hypnotic, 
but the action is easily prevented. Morphine, 
5S7, Morphine and Atropine, 590, is generally 
the best sleep-producer in cases of pain, in some 
kinds of mania, and in melancholia. Humulus, 
592, a hop-pillow, has induced sleep ; lupuline 
is more effective. Phosphorus, 126, under 
some circumstances acts well. Galvanisation, 
421, of cervical sympathetic, causes sleep when 
circumstances are favorable. Water, 77, a 
tepid or warm bath at bed-hour, often suc- 
ceeds. 
Intermittent Fever : 

Cinchona, 193. Quinine is prophylactic ; rightly 
used prevents malarial infection, and in proper 
quantity arrests the paroxysms. In severe 
cases, combination with morphine is very effect- 
ive. An attack impending may be arrested by 
Amyl Nitrite, 648, or Nitro-glycerin, 652, as re- 
spects the chill; Chloroform. 556, by inhalation , 
or by the stomach in a full dose, may prevent a 
chill. Salicin, 361, Salicylic Acid, 368, and 
Resorcin, 376, especially the last named, have 
decided antiperiodic qualities only inferior to 
quinine. Carbolic Acid, 355, hypodermatically, 
seems to be quite effective. Apiol, 736, also has 
very decided antiperiodic qualities. Salicylate 
of Cinchonidine, 379, an antiperiodic of con- 
siderable value. Other substitutes for quinine 
are Nitric Acid, 10S, which acts quite well in 
mild cases; Hydrastine, 169, has some an. 
tiperiodic power, but is an active tetanizer ; 
Eucalyptus, 176, more adapted to chronic ma- 
larial poisoning, and for convalescence after at- 
tacks of fever; Oleoresin of Capsicum, 730, 
and Nux Vomica, 441. adjuncts to other and 
more powerful remedies. Antipyrine, 383, 
Acetanilide, 394. and Salol, 379, new contribu- 
tions to the fever-medicines, have antiperiodio 
powers. 
Intertrigo : 

Bismuth, 153, dusted over the surface. Zinc- 
Ointment, 303, Tannin, in powder, 323. 
Intestinal Catarrh : 

Ammonium Chloride. 226. Bismuth, 153, is 
one of the best remedies. Calomel, 272, in 
minute doses frequently. Nitrate of Silver, 
284, Sulphate of Copper, 291, Acetate of Lead > 
296, Sulphate and Oxide of Zinc, 301, are ex- 
cellent remedies, valuable in the order named. 
The vegetable tonic astringents, Eucalyptus, 
175, Hydrastis, 179, and those containing Tan- 



790 



CLINICAL INDEX. 



rtio Acid, 821, are also useful. Salol, 379, of 
special value because of the action of the pan- 
creatic secretion and the more powerful germi- 
cides and antiseptics, 340 et seq. 
Intestinal Parasites : 

Calomel, 272, for the round worm; also Hydro- 
cyanic Acid, 644. Carbolic Acid, 356, but 
especially Glycerin, 75S, for intestinal trichina- 
Eemedies against the round worm, 713, San- 
tonin, Spigelia, etc. Papdine, 99, a solvent. 
Intussusception : 

Effervescent Enemata, 712 ; also Irrigation, 711, 
acting mechanically. Tobacco Enema, 638, to 
relax spasm. Morphine, 532, hypodermatically 
of first importance. Belladonna, 482. 
Iritis : 

Atropine, 486, to prevent adhesions, and check 
inflammation by emptying vessels of iris. Ese- 
rine, 633, now much employed to break up ad- 
hesions and diminish intra-ocular tension ; also, 
Homotropine, 490. Pilocarpine, 626, to cause 
absorption of exudations and effusions. Mer- 
cury, 272, of great importance, as most cases 
are specific. Duboisine, 498, is much employed 
as a substitute for atropine. 
Jaundtce : 

Aliment, 59, especially the skim-milk cure, avoid- 
ance of fats, etc. Alkalies, 206, and the Alka- 
line Mineral - Waters, 218, Phosphate of Soda, 
131, the most useful remedy in catarrh of bile- 
ducts, and in incipient sclerosis. Chloride of 
Ammonium, 226, and the Iodide, 245, and Io- 
doform, 259, are beneficial under the same cir- 
cumstances. JIanganese, 146, and Perman- 
ganate of Potassa, 147, have unquestionable 
cholagogue effects, and stimulate the discharge 
of bile ; are adapted to the catarrhal form, and to 
the jaundice of gouty subjects. The resin-bear- 
ing cathartics, Rhubarb, Aloes, Podophyllum, 
Iris, and Euonymin, 695-706, promote the ex- 
cretion of bile. Nitro- Muriatic Acid, 106, in- 
ternally and by bath, has long had good repute 
in malaria] jaundice. Benzoic Acid, 390. and 
Benzoates, 391, remove bile from system. Sa- 
lol, Pyridine, and Naphthaline are useful in 
all cases of catarrhal jaundice. Mercurials, 
271, are of doubtful utility, but good results 
seem to be obtained from small doses of calo- 
mel. 
Joints, Diseases of: 

Carbolic Acid, 361, in solution injected in syno- 
vitis, with reported good results. Galvanism, 
427, highly useful in chronic affections. Mas- 
sage, 94, produces remarkable results in stiff- 
ness and deformity of joints from inflammation 
and lack of use. Oleate of Mercury and Mor- 
phine, 277, is of great service in inflammatory 
affections of joints. Nitrate of Silver in Ni- 
trous Ether, 2S7, an efficient application to 
check inflammation. Blisters, 74S, a succes- 
sion of them about the joints, in cases of syno- 
vitis. 
Keratitis : 
Atropine, 487, to check inflammation by causing 
contraction of the vessels. Eserine, 634, lowers 
intraocular tension and relieves pain. Pilocar- 



pine, 626, is of great service in removing exu- 
dation and stopping inflammation. Calomel, 
277, and Yellow Oxide, 277, in powder locally, 
very effective. Zinc Sulphate, 302, in solution, 
is an ordinary lotion in these cases, and is often 
prescribed with atropine. Lead lotions must 
be used with caution. 

Labor : 
Anaesthetics, 557, 55S ; Chloral, 569, relieves pain 
and stops irregular action. Ergot, 458, is ad- 
ministered to hasten labor under suitable condi- 
tions, to cause expulsion of placenta, and to 
arrest haemorrhage. Morphine, 589, £91, hypo- 
dermatically, stops "false pains." 

Lactation : 
Belladonna, 489, arrests the secretion of milk ; a 
solution of atropine may be applied to the gland. 
Pilocarpus, 626, increases secretion of milk. 
Phosphates, especially Phosphate of Lime, 
131, are highly useful in the debility of lacta- 
tion. 

Laryngismus Stridulus : 

Quinine, 197, administered in the interval, may 
prevent attacks that recur frequently. Nitro- 
glycerin, 652, will speedily allay the spasm. 
An Anaesthetic, 556, will at once stop an attack ; 
a few drops of ether inhaled will usually suf- 
fice. Bromides, 602, will suspend attacks if a 
sufficient quantity is given, and prevent recur- 
rences. Tartar Emetic, 306, a nauseant, will 
stop the spasms, but may induce dangerous de- 
pression in young children. Subsulphale of 
Mercury, 677. is as effective and safer. Ipecac^ 
6S2, will also arrest attacks. Chloride of Gold 
and Sodium, 280, highly useful in respiratory 
neuroses. 

Larynx, Diseases of : 
Aconite, 657, in acute catarrh, small dose of the 
tincture often administered. Inhalations, 8, 
of various astringent and anodyne substances : 
also, Insufflation, 7, of the same in powder ; 
Tannin, Iodo-Tannin, Iodoform, Iodoform and 
Tannin, 252 et seq., Nitrate of Silver, Copper 
and Zinc Salts, Nitrate of Bismuth, Monsel's 
Iron, Alum, Sulphurous Acid, 238, Bromine, 
Iodine, Oxygen, Chlorine, Quinine, Benzoin, 
Benzoate of Soda, Eesorcin. Salicylic Acid, Car- 
bolic Acid, and the Antiseptic group, 340 et 
seq. 

Lead-Poisoning : 
Sulphuric Acid, 296, forms the insoluble sul- 
phate ; Magnesium Sulphate, 691 ; for the 
constipation, and for the cachexia, a combina- 
tion of sulphates of quinine and iron, and di- 
lute sulphuric acid. Sulphides, 23S. Alum, 
314, is an effective purgative and anodyne in 
lead-colic ; also, alum whey. Iodides. 249, and 
Bromides, 598, form soluble combinations and 
cause excretion of lead. For the paralysis Gal- 
vanism and Faradism, 425, 428. and Strych- 
nine, 442. 
Lentigo : 

Glycerite of Iodine, 251, 25S, locally. Taimin, 
323. Alum, 316. 
Leucocythemia : 

Oxygen Inhalations, 342, improve the quality of 



CLINICAL INDEX. 



791 



the blood. Iron, 139, is of little value in the 
real, but highly useful in the pseudo-disease. 
Chalybeate Springs, 151, are more useful. 
Phosphorus, 125, and Arsenic, 165, are some- 
times beneficial. Digitalis, 469, in young sub- 
jects does good. Ergot, 456. in the splenic 
form. Electricity, 4'20, as central galvanization, 
is very beneficial. Transfusion, 22. 

Leucobbhcea : 
Alum, 315. is a cheap and useful injection ; may 
be combined with zinc and borax, in a lotion. 
Bismuth, 154, suspended by mucilage or glycer- 
ine, is an excellent injection : may be advan- 
tageously combined with Fluid Extract of 
Hydrastis, ISO, which is one of the best as- 
tringent applications. Lead, 298, the acetate 
or Goulard's extract properly diluted, is an ex- 
cellent topical application. Zinc, 303. lodo- 
Tannin, 252, Tannic Acid, 323. and Iodoform 
and Tannin, 258, packed about the cervix, is a 
highly efficient treatment. Carbolic Acid, 357, 
diluted and used with care, is an excellent de- 
odorizer when the discharges are foul; may be 
combined with the preceding lotions; also 
Triehlorphenol, 360, Boracic Acid solutions. 
Naphthalin, 385. Resorcin, 376. MonseVs 
Solution, 144, is a good application, but stains 
clothing. Common Red Wine (Ives's seed- 
ling), 534, is a good lotion. 

Lepea: 
Nitric and Sitro- Muriatic Acid, 110, for the 
accompanying indigestion. Arsenic, 163, long 
continued, renders important service. Phos- 
phorus, 125. and Phosphates, 132. 

Locomotoe Ataxia: 
Phosphorus, 125, useful to relieve pain and retard 
changes. Nitrate of Silver, 286, has done more 
good than any other remedy, unless Chloride 
of Gold and Sodium, 280, which deserves 
careful trial. Hyoscyamine. 494, especially 
Acetanilide, 394, and Antipyrine. 283, relieve 
the pains. Electricity, 424, especially static, 
the faradic brush, has given great relief. 

Lumbago : 
Acupuncture, 749, and Baunscheidtismus, 749, 
sometimes afford immediate relief. Aqua- 
puncture, 750. is also very promptly curative 
in some cases, and usually relieves. Chloro- 
form, 548, a few drops injected deeply in old 
cases is remarkably beneficial. Cimicifuga, 
478, brings about relief, sometimes completely, 
but often fails. Galvanism, 425 — descending 
stabile and labile currents — usually effects a 
cure. Iodides, 249, are curative when disease 
is due to mercurial, plumbic, or other metallic 
poisoning. Morphine, 587, and with Atropine, 
590, in minute quantity injected into the mus- 
cles affords prompt relief. Salicylic Acid, 
371, and Salol. 380, are appropriate remedies 
in rheumatismal cases. Hydrotherapy, 73, 
79, hot douche to back. Emplastra, 748, the 
various anodyne and healing plasters. Mas- 
sage, 94. 

Lupus : 

Cod-liver Oil, 115. internally and locally. Iodine, 
252, and Iodoform, 25S, in strumous and syphi- 



litic cachexia, and iodoform, etc., to ulcer. 
Arsenic, 163, Fowler's solution long continued 
exerts a curative influence, and arsenious acid 
locally. Zinc Sulphate, dried, 302, a manage- 
able and efficient caustic. Carbolic Acid, 356, 
undiluted, to sore, and diluted injected beneath. 
Corrosive Sublimate, 278, the first of germi- 
cides. Chromic Acid, 758, a very powerful 
caustic, causing but little pain. Potassa 
Chlorate, 214, Bismuth, 154, Bromides, 603, 
in powder, dusted over ulcer, have lately been 
used with great success. Galvano-caustic, 
428, is an elegant and efficient topical agent. 

Lymphoma oe Lymphadenoma : 
Arsenic, 165, persistently used, has good effects. 
Phosphorus, 126, has seemed to cure, but has 
usually failed. Iodides of Iron and Manga- 
nese, 146; the sirup has improved the general 
state, and retarded the progress of the dis- 
ease. 

Malaeial Cachexia : 

Quinine, 192, is the most important remedy. 
Salicylate of Cinchonidine, 193, Cinchonine 
and its salts, 193, and Chinoidin, 193, other alka- 
loids of cinchona, valuable substitutes for qui- 
nine. Benzoates, 391, Antipyrine, 3S1, Resor- 
cin, 376, Salol, 330, Pyridine, 386, and other 
antiseptics. Carbolic Acid, 356. Eucalyptus, 
176, is an excellent remedy for the convalescence 
and for the cachexia. The Bitters, 169, are 
also highly useful under the same conditions. 
For the anaemia, Iron, 139, is invaluable ; it 
acts more efficiently in the cachexia when com- 
bined with Arsenic, 163, which is also an im- 
portant remedy in malarial cachexia. Iodide 
of Iron and Manga?iese, 146, is also a valuable 
restorative. For the changes in the spleen and 
liver, Compound, Solution of Iodine, 246, 
Iodide of Ammonium, 246, and externally 
to the splenic region Ointment of the Red 
Iodide of Mercury, 277, are extremely effect- 
ive. 

Mania, Acute : 
Anaesthetics, 556, Paraldehyde, 538, Hypnone, 
542, and Zfrethan, 541, are safe and useful 
remedies; Chloral, 568, is more active, but not 
without danger. Conine, 603, especially the 
Bydrobromate, without, but especially with, 
morphine hypodermatically, has sometimes 
succeeded in curing acute mania with great 
motor excitement. In the acute cases with 
great restlessness, Gelsemium, 617, Duboisia, 
498, and Hyoscine, 496, have induced quiet and 
occasionally effected a cure. Hyoscy amine, 
494, has become an important remedy as a 
calmative and hypnotic. Digitalis, 468, has 
proved beneficial in paroxysmal excitement of 
general paresis, and in acute epileptic mania. 
Yeratrum Viride, 663. has acted well under 
the same circumstances. Water-Cure, 7S, as 
warm bath and pack, a valuable calmative. 

Mania, Cheoxic : 

Ergot, 456, is highly beneficial in chronic mania 

with lucid intervals, and in epileptic mania. 

Bromides, 598, are occasionally useful, but not 

sufficiently active. Morphine, 5S5, is the most 




792 



CLINICS INDEX. 



important remedy, but Chloral, 56S, may be 
better at times. Iron, 141, in cases of an anae- 
mic character, may be very useful. Digitalis, 
468, has good effects in chronic mania, in gen- 
eral paresis, etc. Physostigma, 633, has had 
unexpectedly good results in general paralysis. 
Uyoscy amine, 493, and Hyoscine, especially 
for the trembling and as a hypnotic. To this 
should be added Pilocarpine, 626, which has 
been very useful in delirium tremens. 

Mastitis : 
Belladonna, 439, stops secretion of milk and 
lessens blood-supply; a solution of atropine 
brushed over the mamma is the best form. 
Phytolacca, 669, appears to arrest the inflam- 
mation ; the tincture and fluid extract are con- 
venient for administration. Pilocarpus, 626, 
should be tried in severe cases with much in- 
duration. 

Melancholia : 

Opium, 535, small and frequent doses of the 
tincture give best results. Bromides, 599, are 
sometimes highly beneficial, and yet frequently 
fail Cannabis Indica, 510, is a useful and 
promising remedy. Caffeine, 518, has also done 
good. Arsenic, 162, especially combined with 
minute doses of opium, and in a greater degree 
Aurum, 230, give excellent results. Chloral 
Hydrate, 563, does good as a hypnotic. Col- 
chicum, 330, Colocynth, 703, and other agents 
which unload the portal circulation, render im- 
portant service. 

Meningitis. (See Cerebro-spinal Meningitis.) 
For the acute condition before exudation, or dur- 
ing the stage of excitation, Opium, 5S3, is a 
remedy of the highest importance ; Chloral, 
567, checks exudation ; Ergot, 457, Gelsemium, 
617, Pulsatilla, 665, Aconite, 65S, for their 
effects on the congestion. For Hyperpyrexia, 
Quinine, 190, Digitalis, 467, Cold Baths, 79, 
Pilocarpine, 626. During the exudation stage, 
or stage of depression, Ammonium Carbonate, 
228. 

Menorrhagia : 
Bromide of Potassium, 603, often arrests prompt- 
ly, and is best adapted to cases of ovarian exci- 
tation. Ergot, 459. in the menorrhagia of sub- 
involution. Cannabis Indica, 511, sometimes 
very useful. Digitalis, 465, in cases of mitral 
disease, or when arterial tension is very low. 
Ipecacuanha, 634, is remarkably beneficial in 
puerperal menorrhagia, and may be advanta- 
geously combined with ergot. Gallic Acid, 
321, sometimes succeeds well. Aloes, 700, is 
indicated in cases dependent on fecal accumu- 
lations, in relaxed habits. 

Mentagea : 

Copper Sulphate, 292, Zinc Sulphate, 303, and 
Silver Nitrate, 233, lotions. 

Meecurialismus : 
Iodides, 249, combine with metal and cause its 
excretion by kidneys, chiefly. Bromides, 59S, 
it is asserted, have the same effects. Bella- 
donna, 432, is the best remedy for the ptyalism. 
Tannin, 323, Red Wines. 530, and Brandy 
and Water are efficient mouth-washes. Qui- 



nine, 190, and the Mineral Acids, 106, for the 
systemic depression. Hyoscyamine, 494, is a 
good remedy for mercurial trembling. 

Metritis: 

Water, SO, hot vaginal douche has good effects. 
Carbolic Acid, 356, undiluted or diluted, ap- 
plied on cotton-wrapped probe to the lining of 
the uterine cavity. Nitric Acid, 111, the fum- 
ing acid, is also applied directly to the cervical 
canal. Potassa Fusa, 214, to the uterine neck 
to cure indurations. Ergotin, 457, persistently 
used, has great value in chronic interstitial me- 
tritis. Aurum, 230, chloride, very effective in 
chronic induration of the uterus. Nitrate of 
Silver, pure and in solution, 287, is much em- 
ployed, topically, in metritis. Iodine, 251. Iodo- 
form, 253, and various solutions, are freely 
used. Leeches, 755, to the cervix, give good 
results. Saline laxatives, 693, and Saline 
Mineral -Waters, 218, are useful in plethoric 
subjects. 

Migraine : 
Ammonium Chloride, 226, a full dose may cut 
short an attack. Cannabis Indica, 510, often 
succeeds. Guar ana, 521, Caffeine, Cuca, 518, 
will usually arrest a seizure. Ergot, 457, cures 
the congestive form, and Amyl Nitrite, 643, 
or Nitro- Glycerin, 652, the anaemic. Bella- 
donna. 439, relieves those cases accompanied 
by vaso-motor spasm, and Digitalis, 468. those 
with low tension of the vessels and weak heart, 
or those dependent on a mitral lesion. Bro- 
mides, 593, if sufficient doses are given, will 
arrest impending attacks. When reflex from 
stomach disorder, an emetic of Ipecac, 682, 
will stop ; if a symptom of intestinal indiges- 
tion, Phosphate of Soda, 129. Antipyrine, 
3S3, Acetanilide, 3?4, are new antiseptic rem- 
edies of value. Diet, 59, is of the first conse- 
quence in the cases of stomach origin. 

Myalgia : 
Ammonium Chloride, 226, sometimes affords 
relief. The Salicylates, 371, Salol, 379, and 
Acetanilide, 394, are more efficient. Elec- 
tricity, 425, rarely fails to cure; galvanism 
and static electricity, and very rapidly inter- 
rupted faradic, may alike succeed. Counter- 
irritation by Firing, Aguapuncture, 750. and 
Acupuncture, 749, will usually relieve. When 
a rheumatic condition is the cause, and there 
is debility from malarial poisoning, Salicylate 
of Cinchonidine, 371, will cure ; when a min- 
eral poison, the Iodides, 249. Massage, 94, 
will usually do good. 

Myelitis : 
When idiopathic, Ergot, 457, Chloride of Bari- 
um, 231, Galvanism, 426, are the most appro- 
priate remedies ; when specific, Mercury. 272, 
or the Iodides. 248. Hydrotherapy, 79, es- 
pecially the tepid rubbing wet pack. Mas- 
sage, 94, to the damaged muscles. After 
acute symptoms, or in chronic cases, Strych- 
nine, 439, Picrotoxin, 447, and similar excit- 
ants are proper. 

N^evi: 

Chromic Acid, 756, readily destroys with little 



CLINICAL INDEX. 



793 



pain. Galvano-causty, 428, is a good means 
of removing them. Nitric Acid, 111, is also 
an efficient caustic. Collodion, 760, by me- 
chanical compression in drying, will sometimes 
cure. 

Narcosis. (See Antidotes.) 
Ammonia, 227, by inhalation, especially by in- 
travenous injection, in failure of the heart's ac- 
tion. Oxygen inhalations, 312, in chloroform 
narcosis. Faradism, 422, to stimulate the 
respiratory center by reflex irritation, and the 
respiratory muscles directly. Amy I Nitrite, 
649, by inhalation in cardiac failure. Water, 77, 
the cold douche and cold affusion in cerebral 
narcosis, prussic-acid poisoning, and sunstroke, 
etc. Ether-injections, 515. Heat, 85, in alter- 
nation with cold. Emetics, Apomorphine, 679, 
Sulphate of Copper, 291, Sulphate of Zinc, 
301, etc. 

Neuralgia : 
Aconite, 652, when there is febrile excitement ; 
Aconitine, 654, is particularly effective in neu- 
ralgia of the fifth nerve. Alcohol, 529, in suf- 
ficient quantity, is an anodyne, but the alcoholic 
habit is quickly formed. Anaesthetics, 556, 
promptly relieve. Cod-liver Oil, 116, is of 
great value as a nutrient. Chloroform, by 
deep injection, 548, is very effective in old neu- 
ralgias. Croton- Chloral, 570, is useful in neu- 
ralgia of the fifth. The new anodynes and 
hypnotics, Urethan, 541, Hypnone, 542, Co- 
caine, 515, and for pains of locomotor ataxia, 
Antipyrine, 383, Antifebrine, 394, and others. 
Morphine, 5S7, subcutaneously, is the most 
efficient remedy for the relief of pain. Aqua- 
puncture, 750, often remarkably beneficial. 
Belladonna, 435, especially atropine subcuta- 
neously, in tic-do uloureux and sciatica, but full 
doses must be administered. Arsenic, 162, 
benefits by improving the nutrition. Bro- 
mides, 602, are useful in some cases ; Cimici- 
fuga, 478, and Gelsemium, 618, do good in 
simple neuralgia of the fifth, and in ovarian 
neuralgia. Galvanism, 425, is, next to subcu- 
taneous injection of morphine, the most decid- 
edly curative agent. Massage, 94, gives much 
relief. Copper, Ammoniated, 291, in neural- 
gia of the fifth, has been revived lately. Iron, 
142, is required in anaemia, the usual condition. 
Phosphorus, 127, has proved curative in suit- 
able cases, if pushed. Nitrite of Amyl, 650, 
by inhalation, and Nitro- Glycerin, 652, by the 
stomach in neuralgic dysmenorrhea. Strych- 
nine, 440, long continued in depressed states of 
the nervous system. Turpentine, 721, in re- 
flex cases. Veratrine, 658, the ointment in 
superficial neuralgia. The Antiseptic Oils, 
396, locally. Chloral and Camphor, 569, with 
Morphine, applied to the seat of pain. Wet 
Pack, 84, in sciatica, etc. Heat, 84. 

Nymphomania : 
Bromide of Potassium, 603, but large doses are 
requisite. Camphor, 502, and Camphor Mon- 
obromata, must also be given in large doses. 
Tobacco, 638, Hydrobromate of Nicotine, 638, 
carried to nausea. 



Obesity : 
Banting System, 46. Alkalies, 207, and Alka- 
line Mineral -Waters, 218. Bromide of Am- 
monium, 59S. Potassa Permanganate, 152, 
for the attendant dyspepsia. The Vegetable 
Acids, 233. 

Onychia : 
Chloral, 569, a solution applied locally. Iodo- 
form, 251, in powder or ointment. Nitrate of 
Lead, 29S, as powder, in glycerin, or as oint- 
ment, the most effective of all remedies. 

Ophthalmia : 
Mercury, 277. Calomel dusted over the conjunc- 
tiva. Tannin, 323, also dusted over the mem- 
brane. Alum, 316, in solution in rose-water. 
Atropine, 489. Eserine, 633, to diminish intra- 
ocular tension. Pilocarpus, 626. Conium, 
608, the alkaloid conine or the succus in blepha- 
rospasm. Nitrate of Silver, 2S8, Zinc Sul- 
phate, 303, and other mineral astringents. Ja- 
quirety, 751, in granular lids by substitutive 
inflammation. 

Orchitis : 
Ice, 80, in a bag kept applied. Iodine, 252, tinct- 
ure, locally. Mercury, Oleate of, 277, painted 
over. Nitrate of Silver, 288, in nitric ether, 
painted over. Ammonium Chloride, 229, in 
solution with alcohol. 

OTORRH03A : 

Lead, 298, lotions of. Silver Nitrate, 288, in 
solution. Tannin, 323, the glycerite, locally. 
Zinc Sulphate, 303. Mercury, 277, the brown 
citrine ointment. Cadmium, 309, in solution 
in water. Sulphocarbolates, 359. 
Ovarian Cysts : 
Iodine Injections, 252, of tincture or compound 
solution, but adapted only to unilocular cysts. 
Electrolysis, 428, also only in single cysts. 

OXALURIA : 

Nitro- Muriatic Acid, 110, has special utility. 
Nitric Acid, 106, before meals in acid indiges- 
tion and excess of uric acid. 
OzjEna : 

Bromine, 346, inhalations of vapor very cautious- 
ly. Carbolic Acid, 356, solution injected, 
spray inhaled. Carbolate of Iodine, 356, 
iodine and carbolic acid vaporized and inhaled. 
Ethyl Iodide, 253, by inhalation. Iodoform, 
258, vaporized or solution in ether applied. 
Iodine, 250. inhaled. Bichromate of Potassa, 
214, solution injected. Iodoform, iodo-tannin, 
bismuth, zinc oxide, resorcin, thymol, and simi- 
lar agents applied by Insufflation, 6. 
Pain. (See Neuralgia..) 

Opium, 5S7, in any form, but especially morphine 
subcutaneously, best of all agents for the relief 
of pain. Belladonna, 485, especially atropine 
alone or in combination with morphine. Anaes- 
thetics, 556, give immediate relief. Aconite, 652, 
and its alkaloid, aconitine, relieve pain, espe- 
cially of fifth nerve. Cannabis Indica, 510, 
has slight anodyne properties. Chloral, 569, 
does not relieve pain directly, but by stopping 
spasm, unless in dangerous narcotic doses. 
Croton - Chloral, 570, induces anaesthesia of 
fifth nerve. Gelsemium, 615, has feeble anodyne 



794 



CLINICAL INDEX. 



properties; Ci)nicifuga, 47$, even less. Gal- 
vanism, 42S. has decided power to relieve pain. 
In nocturnal pain, Iodides, 249, have remark- 
able effects. Aquapuncture, 750, Acupunct- 
ure, 750, Blisters, 74S, and Heat and Cold, 
SO. relieve pain in varying degree. 

Paralysis : 

Cod-liver Oil. 116, favors the restoration of dam- 
aged nerve-elements. Phosphorus, 127, with 
or without oil. as a restorative of nerve-matter. 
Strychnine, 440, an important stimulant, but 
must be used after local troubles in the nerve- 
centers have subsided. Picrotoxin, 445, em- 
ployed under similar conditions to strychnine. 
Galvanism and Faradism, 423, are first in 
importance as remedies in the diagnosis and 
treatment of paralysis; especially adapted to 
the "myopathies of spinal origin." Massage, 
94. an important adjunct to other treatment. 
Hyoscyamine, 495, is very useful in paralysis 
agitans. Eserine, 633, is of great service in 
paralysis of the third nerve. In the paralysis 
due to gummata, Iodides, 249, effect surpris- 
ing cures. Ergot, 457, in vesical paralysis the 
result of overdistension. Metallotherapy, 310. 

Parasites : 
Acetic Acid, 233. in pityriasis versicolor and 
other parasitic skin - diseases. Sulphuroxis 
Acid, 235, destroys sarcina and itch-insect; 
also Sulphides, 238. Mercury, 276, the cor- 
rosive chloride, is very effective in the various 
parasitic skin affections. Salicylic Acid, 371, 
Carbolic Acid, 350, Resorcin, 376, Salol, 3S0, 
Pyridine, 3S6, Antipyrine, 383, and other 
antiseptics. Boracic Acid, 3S8, Bensoates, 
390, are useful in same group of affections. 
Glycerin, 75S, destroys trichina. Anthelmin- 
tics, 713, contain the most effective parasiti- 
cides of the intestinal canal. 

Pemphigus : 
Arsenic, 163, cures the chronic form. Bella- 
donna, 4S7, for the acute stage. 

Peritonitis : 
Aconite, 657, for the febrile movement. Chloral, 
567, for restlessness and delirium, and to de- 
press the temperature. Opium, 5S3, is the 
remedy of highest importance, is best adminis- 
tered as morphine hypodermatically. . Turpen- 
tine, 721, in puerperal peritonitis with depres- 
sion and tympanites. Quinine, 190, in full 
doses, with or without morphine, is of great 
value before the exudative stage. Ammonia, 
226, Potash Salts, 206, during exudation. For 
external treatment: Rubefacients, 746. Tee- 
hag, SO, to abdomen ; also Heat, SO, and Poul- 
tices, 762. Leeches, 755. 

Pernicious Fever : 
Amyl Nitrite, 648, by inhalation to prevent rigor. 
Pilocarpus, 626, Quinine, 190. in lar°re quan- 
tity by the stomach or hypodermatically; Mor- 
phine, 5S3, also, if not contra-indicated. Chlo- 
roform, 54S, in time to prevent the depression 
of the cold stage. 

Perspirations : 
Aromatic Sulphuric Acid, 109, is an ancient 
remedy of value, but in some respects objection- 



able. Atropine, 4S7. is one of the most useful 
remedies for " night-sweats," and locally applied 
for sweats in various local situations. Picrotox- 
in, 447, a minute dose, will stop for several nights 
the sweats of consumption. Muscarine and 
Agaric Acid, 669, are also serviceable remedies. 
For sweating of the feet, Salicylic Acid, 372, 
in powder, dusted over the feet and stockings, 
is probably the best remedy ; may also be used 
in lotion with borax. Permanganate of Po- 
tassa, 156, is an elegant toilet deodorant in 
fetid sweating of axillae and feet. Oxide of Zinc, 
301, with extract of belladonna in pill, is an or- 
dinary remedy for night-sweats ; also Gallic 
Acid, 322. 

Phagedena: 
Bromine, 346, pure, applied with a glass rod, is a 
good escharotic, but not easily managed, owing 
to its volatility. Carbolic Acid, 356, superficial 
in its effects, but very useful in mild cases. 
Chlorate of Potassa, 214, in powder a man- 
ageable and efficient remedy. Salicylic Acid, 
371, in powder, to the slouching and normal 
tissue adjacent. Resorcin, 375, in powder, ap- 
plied in the same way, and Boracic Acid, 378, 
accomplish good results by changing the char- 
acter of the local action. Chloride of Zinc, 
303, and Nitric Acid, 110, are powerfully de- 
structive. Iodoform, 288. Internally: Iodide 
of Iron, 141, Quinine, 197, Phosphates, 131, 
and the tonics and restoratives in general. 

Pharyngitis, Follicular : 

In the acute inflammation — Aconite and Bella- 
donna, 483. For local application — Tannin, 
323, Tannin and Iodoform, 252, Iodoform, 

254, in powder or ethereal solution, Alum, 316, 
Cubebs, 728, in powder— the powders by insuf- 
flation. Nitrate of Silver, 288, in solution, 
painted over the surface. Hydrastis, 179, the 
fluid extract, an excellent topical application to 
mucous membrane, inflamed. 

Phlegmon : 
Carbolic Acid, 356, a solution injected as an 
antiseptic. Iodine, 247. the tincture or com- 
pound solution injected after removal of the pus 
to prevent decomposition. Nitrate of Silver, 

255, 2S9, a solution in nitrous ether painted 
over the inflamed area, may abort the abscess. 
Sulphides, 238, promote formation of matter, 
or extrusion and healing. 

Phosphorus-Poisoning : 
Sulphate of Copper, 120, forms insoluble phos- 
phide and induces active emesis. Turpentine, 
120, the acid or French, or old turpentine, ex- 
posed to or mixed with air, and not rectified 
fresh turpentine. Transfusion. 115. to replace 
damaged blood-corpuscles, has saved life. 

Phthtsis : 
Alcohol, 529, an important remedy when it pro- 
motes appetite and digestion, and increases the 
body-weight. Aliment, 4S, 52, fresh blood, 
fals, and nitrogenous food. Oxygen, 342, Hy- 
drogen Dioxide, 343, Gas Injections, 346. 
Benzoate of Sodium, 391, in spray, has been 
proposed as a specific, and already discredited. 
Chloride of Calcium, 212. has had remarkably 



CLINICAL INDEX. 



795 



good effects in some cases. Cod-liver Oil, 115, 
is both a valuable food and a remedy ; ether 
aids its digestion by increasing the pancreatic 
juice, and quiets the stomach. Mineral Acids, 
109, especially nitro-muriatic in large doses, 
greatly improve the condition of some cases 
and retard the progress of the disease. Car- 
bolic Acid, 35-4, has been used, with great 
advantage by inhalation to destroy the fetor of 
the expectoration, and to act on the local mor- 
bid process ; systemically. the acid helps diges- 
tion and stimulates the assimilation. Creosote, 
354, has been used with remarkable success 
recently. Phosphates and Hypophosphites, 
132, Cuca, 514, with or without cod-liver oil, 
have good effects in the more chronic cases. 
Arsenic, 162, improves digestion and the for- 
mation of tissue, and increases the respiratory 
capacity. Strychnine, 441, checks the vomit- 
ing, and is a valuable respiratory stimulant. 
For the night-sweats, Picrotoxin, 447, Atro- 
pine, 482, and sometimes Pilocarpine, 572. 
For the cough, Primus Virginiana, 176, Bro- 
mides, etc. 

Pityriasis : 
Acetic Acid, 233, will destroy the parasite and 
cure. Borax, 214, is a good application in 
pityriasis of the scalp. Bichloride of Mercury, 
277, in solution, if strong enough, is a certain 
cure for pityriasis versicolor. Oleate of Mer- 
cury, 277, may also succeed. Carbolic Acid, 
356. and Myrtol, 396, will destroy the parasite 
of pityriasis versicolor. The Sulphides, 238 ; 
sulphide of potassa in lime-water is an excel- 
lent application. 

Pletjbitis : 
Aconite, 657, is a valuable remedy for the febrile 
stage. Bloodletting, 755, by cups or leeches, 
is a good expedient in the initial stage in ple- 
thoric subjects. Blisters, 74S, are useful at two 
periods : at the onset and as resolution begins. 
Digitalis, 467, is an antiphlogistic, adapted to 
the pre-exudative stage. Iodide of Potassium, 
256, is useful to promote absorption of the exu- 
dation, and tincture of iodine or compound solu- 
tion injected to prevent reaccumulation of fluid. 
Quinine, 190, reduces temperature and checks 
exudation. Morphine, 583, is the most impor- 
tant remedy until exudations occur ; quinine 
and morphine in sufficient quantity at the out- 
set may abort. Chloral, 567, is extremely use- 
ful when there are restlessness and delirium. 
Pilocarpus, 626, causes absorption of exuda- 
tion. 

Pneumonia : 
Aconite, 657, Veratrum Viride, 663. and. Digi- 
talis, 467, very valuable antipyretics and anti- 
phlogistics for the stage of congestion. Car- 
bonate of Ammonia, 227, Iodide of Ammoni- 
um, 256, for the liquefaction of the exudation. 
Turpentine, 721, a valuable stimulant when 
circulation is feeble, and in gangrene. The 
subcutaneous injection of ether, 545, in ady- 
namic condition remarkably effective. Quinine, 
190, an important remedy under two condi- 
tions : in large doses during congestion, and in 



small tonic doses as a stimulant when depres- 
sion comes on. Wet Pack, 76, and the cold 
bath, the latter as a remedy for the inflamma- 
tion, according to Jiirgensen, the best. Ser- 
pentaria, 170, stimulant expectorant. Mus- 
carine, 669, is a highly promising remedy. 
Morphine, hypodermatically, 5s3. Blisters, 
726, useful at onset, and to promote resolution. 
Copper Sulphate, 292. 

Polyuria : 
Dry diet, 47, of great value. Chloride of Gold 
and Sodium, 2S0, persistently used, an im- 
portant remedy. Opium, 5S3, large doses are 
necessary, and therefore extreme danger of 
forming a habit. Ergot, 457, the most benefi- 
cial remedy thus far known, probably. Pilo- 
carpus, 626, has been used with success. 

Pokrigo : 
Manganese, 147, an ointment of the oxide. Ole- 
ate of Mercury, 277, has succeeded. Iodide 
of Lead Ointment, 298, in chronic cases. 

Prostate, Hypertrophy of : 
Alkalies, 207, in acid urine, and Benzoate of 
Ammonia, 391, for acid urine. Tincture of 
Iodine, 256, injected through the walls of the 
rectum. Iodoform, 254, by suppository in the 
rectum. Sulphides, 237, are supposed to in- 
duce absorption. Injections of Ergoiin, or 
Ergot internally, 457, the most certain means 
of reducing the size of the organ. 

Prostorruosa : 
The Urino- Genital Remedies, 718, et seq., nota- 
bly Cantharis, Turpentine, Cubeb, and Co- 
paiba. Hydrastis, ISO, fluid extract, inter- 
nally and applied locally. Tincture of Chlo- 
ride of Iron, 143, when there is much debility. 
Bromide of Potassium, 603, Avhen there are 
irritability and excitement. Ergot, 457, when 
relaxation exists. 

Prurigo : 

Carbolic Acid, 356, locally and also internally. 
Alkaline Warm Baths, 208, at bed-hour. Bel- 
ladonna, 489, internally, sometimes relieves 
remarkably. Prussia Acid, Potassium Cya- 
nide, 645 and 646, in solution, is effective, but 
must be used with caution. Pilocarpus, 626, 
does good when skin is dry and harsh. Gal- 
vanism, 427, has special value in cases of neu- 
rotic origin. Sulphides, 238, afford relief in 
bath or as an ointment. 

Prvbitus "Vulvae : 
Borax, 207, a saturated solution freely applied ; 
also Potassium Bicarbonate, 207, in solution. 
Bichloride of Mercury, 211, in solution of 
sufficient strength. Oleate of Mercury, 279. 
Cyanide of Potassium, 646, as an ointment or 
in solution, if strong enough, relieves greatly, 
but must be used cautiously ; also Hydro- 
cyanic Acid, 645, diluted, which may be pre- 
scribed in lotion, with borax. Nitrate of Silver, 
287, a solution painted on the affected parts, 
gives great relief. Sulphites, 230, also as a lo- 
tion. Oleates of Mercury and Morphine, 279. 

Psoriasis: 
Cod-liver Oil, 117, of the greatest value both in- 
ternally and locally in cases of strumous origin. 



96 



CLINICAL INDEX. 



Arsenic, 163, in chronic cases ; may increase 
the disease at first, but persistently used may 
effect a cure. Phosphorus, 127, acts similarly 
to arsenic, and may accomplish better results. 
Locally— Xitrate of Silver, 287, Lead— oint- 
ment of the iodide, 29$, Coptis, 169, especially 
useful in psoriasis of the tongue, and Sulphur 
Baths, 239. 
Pttalism : 

Belladonna, 482; also, Hyoscyamine and Du- 
boisine, of same group, very effective in mer- 
curial, and ptyalism of pregnancy. In some 
rare examples, Pilocarpine, 626, effective. Lo- 
cally— Tannin, 252, Brandy, 530, and the 
Vegetable Astringents, 323 et seq. 
Puerperal Convulsions : 

Anaesthetics, 556, especially chloroform ; the re- 
lief is temporary, but time is gained for other 
measures. Chloral, 563, in considerable doses 
is useful. Morphine, 536, hypodermatically, is 
the most valuable agent in the ura?mic form, 
but full doses are necessary. Amyl Nitrite, 
649, by inhalation, may do good in cases char- 
acterized by high tension of the vessels. Vera- 
trum Viride, 663, has proved to be a success- 
ful remedy— " invaluable." Bloodletting, 755, 
is necessary when there is cerebral congestion. 
Bromides, 600. 
Puerperal Fever : 

Quinine, 190, in large doses, first in importance. 
Opium, 5S3, when there are wakefulness and 
delirium, especially when local peritonitis ex- 
ists. Salicylic Acid, 36S, and the Salicylates, 
Resorcin, 376, and Carbolic Acid, 354; also, 
of same class, Salol, 380, Antipyrine, 383, 
Acetanilide, 394, and all effective antipyretics, 
are remedies of great value. Turpentine, 721, 
when there is much tympanites or depression. 
Potassa Permanganate, 147, has been used 
with success internally. 
Puerperal Mania : 

Anesthetics, 556, may be necessary in violent 
cases. Bromides, 599, will quiet, in cases with 
tendency to cerebral congestion. Chloral, 56S, 
is a highly serviceable hypnotic, but its per- 
sistent use in anaemic cases is harmful. Du- 
boisine, 497, Hyoscyamine, 494, and Hyos- 
cine, 496, are probably the best hypnotics when 
there are much excitement and restlessness, as 
well as wakefulness, and the most successful 
when there is much motor excitement Cha- 
lybeates, 141, and Quinine, 192, are neces- 
sary when there is debility. Morphine, 536, 
under some circumstances is the best hyp- 
notic. 
Puerperal Peritonitis : 

Opium, 5S5, is the most important remedy, and 
is probably curative. Quinine, 191, in consid- 
erable doses, is next in value ; a combination of 
quinine and morphine. Turpentine, 721, is in- 
dicated in a condition of systemic depression 
and when tympanites is present. Ice, 75, Seat, 
84, to the walls of the abdomen. 
Purpura : 

Digitalis, 466, to overcome the low tension. 
Ergot, 456, slows the heart and raises the ten- 



sion, and thus checks transudations. Suh 
phtiric Acid, 110, Gallic Acid, 322, Acetate 
of Lead, 297, are astringents of more or less 
value. Turpentine, 721, is of great value 
usually. Iron, 139, is usually indispensable, 
especially the tincture of the chloride. 

Pyaemia : 
Quinine, 190, in large doses, Salicylic Acid, 368, 
Resorcin, 376, Salol, 380, Antipyrine, 383, 
and the Antiseptics in general, are useful in 
varying degree. Alcohol, 528, and the Malt 
Liquors, 536, have an important place. 

Pyelonephritis : 
Eucalyptus, 176, and the Urino-genital Reme- 
dies, especially Cantharis, 740, Turpentine, 
722, Pipsissewa, 732, Erigeron, 731, Gallic 
Acid, 322, and the Antiseptic group, 3S8 et seq. 

Eemittent Fever : 

Quinine, 190, curative in efficient doses. Resor- 
cin, 376, Salicylic Acid, 368, Antipyrine, 383, 
Acetanilide, 394. and Benzoates, 390, come 
next. 

Eheumattc Arthritis : 
Lithium, 213, and its salts. Iodides, 249, when 
the disease is due to syphilitic, mercurial, or 
plumbic poisoning. Colchicum, 329, when the 
gouty or rheumatic diathesis underlies the dis- 
ease. Cod-liver Oil, 116, internally and locally, 
is adapted to all forms, and one of the best of 
remedies. Arsenic, 163, is beneficial in cases 
of simple character. 

Rheumatism, Acute : 
Aconite, 658, tincture of the root, for the fever, 
Water, 77, cold baths for the condition of hyper- 
pyrexia. Arnica, 620, a remedy for subacute 
cases, and Trimethylamine, 622, which acts 
similarly. The Bromides of Ammonium and 
Lithium, 597, have been warmly commended: 
the latter also useful in muscular attacks. 
Salicin, 361, in full doses, according to Macla- 
gan, the first of remedies ; Salicylic Acid and 
the Salicylates, 369, especially Salicylate of 
Cinchonidine ; Salol, 3S0. has of late been 
much urged, and the Bensoates, 390; also Anti- 
pyrine, 383, and Acetanilide, 334, new and ef- 
fective remedies. Alkalies, chiefly Bicarbon- 
ate of Potassium, 207, a plan of treatment 
very useful under appropriate conditions. 
Iron, 140, tincture of the chloride in full doses 
a valuable remedy in weak subjects. Blisters, 
74S, a succession of. around the affected joints, 
give relief and shorten the disease. Mineral 
Acids, 109, have been warmly advocated. 
Lemon-juice, 233, an adjunct to more effective 
remedies, especially to potash salts. 

EnEUMATis.M. Chronic : 
Alkaline Mineral-Waters. 216 et seq., Sulphur- 
ous Mineral- Waters. 241 The Turkish Bath, 
85. Cod-liver Oil, 116, a very important reme- 
dy. Aliment, 58. Colchicum, 329, in the so- 
called gouty form. Guaiac, 333, is sometimes 
useful. Stillingia. 334. Xanthoxylum, 339, 
and Cimicifuga. 473. give relief in the muscu- 
lar form, and are less beneficial when there are 
joint changes. Iodides. 246, produce excellent 
results in the cases due to metallic poisoning. 



CLINICAL INDEX. 



797 



Manganese Sulphate, 146, does good in cases 
of gouty antecedents. Lithium and its Salts, 
213, afford the best results in uric-acid diath- 
esis. Salicylic Acid, 369, Salicylate of 
Cinchonidine, 371, Salol, 380, Antipyrine, 
3S8, and the other antiseptics. 

Ktckets : 
Aliment, 53, food rich in phosphates, oils, and 
lime. Cod-liver oil, 115, is a most important 
agent in the process of regeneration. Phos- 
phates, 130, especially the lacto-phosphate of 
lime, and Iron, 139, especially the sirup of the 
iodide. Phosphorus, 125, induces a hyper- 
trophy of bony tissue, and should therefore be 
carefully tried in this disease ; it may be ad- 
vantageously given in cod-liver oil. 

Roseola : 
Belladonna, 4S7, is a suitable remedy when any 
remedy is needed, and Inunctions of Oil, 110, 
allay the cutaneous irritation. 

Rubeola : 
Aconite, 658, and Digitalis, 467, are important 
antipyretics and to relieve the catarrhal pro- 
cess. Carbonate of Ammonia, 223, has the 
greatest value in the catarrhal pneumonia when 
a complication. Quinine, 197, is highly useful 
in large doses when catarrhal pneumonia comes 
on. The antiseptic antipyretics, when tem- 
perature is high, Antipyrine, 383, Acetanilide, 
394, and others. For the broncho-pneumonia, 
Iodides, 246, Ethyl Iodide, 254, by inhalation, 
etc. Oil Innctions, 115, allay irritation of the 
skin and lessen the febrile heat. 

Scabies : 
Sulphur-Baths, 238, Sulphites, 233, and Sul- 
phides, 238, freely and faithfully used, are very 
effective. Carbolic A cid, 356, locally destroys 
the parasite, but has caused fatal poisoning, too 
freely used ; also, Cajuput- Oil, 396. Corrosive 
Chloride of Mercury, 276, if strong enough is 
very effective, but caution is necessary. Man- 
ganese, 146, an ointment of the oxide, and 
solution of Potass. Permanganate, 247. Sul- 
phate of Copper, 292, a lotion of, may be used 
successfully. 

SCAELET FEVER : 

Aconite, 653, for the fever and local inflamma- 
tions. Digitalis, 467, a veiy important reme- 
dy as antipyretic and diuretic. Belladonna, 
484, when the eruption is imperfect or bluish, 
the peripheral circulation feeble, and the heart's 
action depressed. Oil Inunctions, 115, dimin- 
ish irritation of the skin and lessen tempera- 
ture. Salicylic Acid, 368. Benzoate of Sodi- 
um, 391. Resorcin, 376, Carbolic Acid, 354, 
Antipyrine, and the other antiseptics and anti- 
pyretics ; spray to the throat, and internally 
for septic infection. Carbonate of Ammonia, 
223, of great value as a remedy and as a 
stimulant to the depressed circulation. Qui- 
nine, 197, employed under two conditions 
—as antipyretic and tonic. Water, 75, cold 
baths and pack, for hyperpyrexia and to de- 
velop the eruption in the fulminant cases. 
Aqua Chlori, 344, is a useful gargle and de- 
odorant mouth-wash. Hydrochloric Acid, 



10S, internally, and diluted as a lotion for mouth 
and throat. 

Sciatica : 
Atropine, 4S7, injected subcutaneously in the 
neighborhood of the nerve, but the physiologi- 
cal effects must be fully induced. Methylal, 
539, a twenty-per-cent mixture with oil, rubbed 
in along the nerve, is said to be very effective. 
Morphine, 587, subcutaneously with or with- 
out atropine, has curative effects. Galvanism, 
425, next to morphine, is the best method of 
cure. Aquapuncture, 750, gives great relief 
in receDt cases. Acupuncture, 749, also Firing, 
749, sometimes relieves. Chloroform, 548, and 
Ether, 545, by deep injection in old cases are 
surprisingly effective. Nitrate of Silver, 289, 
in solution, injected near to the nerve-trunk, 
is curative in some old cases resisting other 
means. Salicylic Acid, 363, Salol, Antipy- 
rine, 338, and Acetanilide, 394. Iodides, 246, 
should be used in cases of syphilitic, plumbic, 
or mercurial cachexia. Turpentine, 722, has 
occasionally succeeded ; also Cuaiac, 333. 

Scleroderma . 

Cod-liver Oil, 115, the most important remedy. 
Phosphates and Hypophosphites, 130, with or 
without cod-liver oil. Phosphorus, 125, in cod- 
liver oil. Galvanism, 420, central galvaniza- 
tion. 

Sclerosis, Spinal: 
Nitrate of Silver, 2S6, very beneficial. Phos- 
phorus, 125. Galvanism, 420, and Static 
Electricity, 424, Electric Brush, 423, Iodides, 
246, when there are specific lesions, and in 
mineral poisoning. Baths, 75, the rubbing wet 
pack. Massage, 94. Oils, 118. 

Scrofula : 

Cod-liver Oil, US, and Inunctions of Oil, 117. 
Phosphates, 130, to improve the nutrition. 
Iron, 141, and Chalybeate Waters, 150. Io- 
dides, 246, of iron and manganese, especially. 
Stillingia, 334, Sanguinaria, 337, and Sarsa- 
parilla, 332, promote the activity of the vegeta- 
tive functions and improve nutrition. 

Sea-sickness : 
Atropine, 486, subcutaneously, in minute quan- 
tity. Chloroform, 547, a few drops by the 
stomach, frequently. Chloral, 567, especially 
useful when there are fever and insomnia, prob- 
ably the most effective remedy, but must be 
given before decided nausea sets in. Sodium 
Bromide, 597 [3ss. — 3j.], begun before em- 
barking, the first of remedies. Champagne, 
534, iced in small quantity, or effervescent 
mixtures, with Bromhydrates of Caffeine, etc. 
Morphine, 581, minute doses subcutaneously. 
Amyl Nitrite, 643, by inhalation, and Nitro- 
Glycerin, 652, by the stomach, are very useful. 
Bitters, as Calumba, 169, and Tincture of Nux 
Vomica, 437, also sometimes succeed. 

Seborrhea : 
Zinc Oxide, 303, ointment. Potassa; Liquor, 
209, locally and internally. Glycerin, 758, per- 
sistently continued by the stomach. 

Septicemia : 

Quinine, 197, in large doses, as an antipyretic and 



798 



CLINIC 1L INDEX. 



antiseptic. Salicylic Acid, 871, Resorcin, 375, 
and Benzoates, 391, are employed for the same 
purposes : to keep down the temperature and 
to destroy septic materials. Bromine, 346, 
Carbolic Acid, 356, and Chlorine, 344, Boracic 
Acid, 37S, the Antiseptic Oils, 396, Potassa 
Permanganate, 247, are all used locally to de- 
stroy sloughing and gangrenous parts, to de- 
odorize, and to change the character of the sur- 
face. Cold BatJis, 77, for hyperpyrexia, and 
Hot Water, 82, for wounds. 

Skin -Diseases : 

Oils and Fats, 117, by inunction and locally. Ar- 
senic, 164, in chronic, scaly skin-diseases. Phos- 
phorus, 125, in place of arsenic and under the 
same conditions. Iodides, 258, when syphi- 
litic, mercurial, plumbic, or other metallic poi- 
sons underlie the local morbid process. Mer- 
cury, 272, 277, of great value in secondary 
syphilitic cutaneous affection. Quinine, 197, 
in ecthyma, erythema nodosum, and when de- 
pression of the vital forces exists. Atropine, 
4S7, is highly useful in certain cutaneous neu- 
roses, and in simple vascular lesions. Pilocar- 
pus, 627, when the skin-secretions are deficient, 
and in alopecia. Jequirety, 752, in the hyper- 
trophic affections. Sarsaparilla, 331, has long 
been celebrated in syphilitic and strumous affec- 
tions of the skin. Mineral Acids, 110, in dis- 
eases secondary to stomachal and intestinal in- 
digestion. Electricity, 427, in the neuroses of 
the skin. Locally, the salts of Zinc, 303, and 
Mercury, 272, Tannic Acid, 323, as glycerite 
or in powder, Carbolic Acid, 356, Sulphocar- 
bolates, 359, Trichlor phenol, 360, and Iodine, 
251, are freely used in various acute and chronic 
affections. Stains of Nitrate of Silver, 2S8, are 
removed by a solution of cyanide of potassium, 
iodine, and water. 

Spermatorrhea : 
Atropine, 4S7, Ergot, 460, and Digitalis, 469, 
when the genitals are relaxed, the erections 
feeble because of deficient filling of veins of 
erectile tissue, and the ejaculator muscles pa- 
retic. Cimicifuga, 478, acts similarly, but less 
strongly. Nux Vomica, 439, or strychnine is 
indicated when a stimulant and tonic are re- 
quired, and Cantharis, 741, under similar cir- 
cumstances. Iron, 144, tincture of the chloride, 
when amsemia is a marked feature, and Arsenic, 
164, as a systemic tonic and genital stimulant. 
Bromide of Potassium, 603, Lupuline, 593, 
and Camphor, 502, when a genital sedative is 
indicated. Locally, Hydrastis, ISO, fluid ex- 
tract, Tannin, 323, and vegetable and mineral 
astringents. 

Spina Bifida. 
Iodine, 252, the tincture injected into the sac. 
Collodion, 760, in drying contracts and me- 
chanically compresses. 

Spinal Irritation: 
Electricity, 427, is an efficient means of allaying 
the pain and tenderness. Strychnine, 439, one 
of the best tonics for the primaiy assimilation, 
and stimulant for the depressed nerve-centers. 
Ergot, 457, is required when active hyperaemia 



is present. Bromide of Potassium, 599, does 
good under the same condition. Mitchell's 
Cure, 95, by massage, rest, and faradism, often 
the best treatment. 

Spleen, Diseases of : 
Eemedies acting on the spleen are, in anaemia, 
Iron, 139, Manganese, 146, and Arsenic, 161 ; 
in vascular dilatation, Ergot, 457, Quinine, 195, 
Belladonna, 4S6, Muscarine, 672, Resorcin, 
376. The most efficient external applications 
are : Cold Affusion, 80, which causes contrac- 
tion of the splenic vessels, Ointment of the Red 
Iodide of Mercury, 277, which, if properly ap- 
plied, causes a rapid reduction of simple hyper- 
trophy, Ointment of Iodide of Lead, 280. 

Sterility : 
Av/rum, 2S0, chloride of gold and sodium, when 
due to chronic interstitial metritis. Phospho- 
rus, 126, when simple functional debility in the 
male is the condition. 

Stomatitis : 
A Icohol, 530, Brandy-and - Water, an excellent 
astringent wash. Bismuth, 154, in powder 
freely applied. Acids, 110, hydrochloric, ap- 
plied directly to ulcers. Eucalyptus, 176, Hy- 
drastis, 180, Rubus, 324, Krameria, 324, and 
other vegetable astringents, the fluid extracts 
being applied pure, or variously diluted to the 
affected parts. Potassium Chlorate, 214, the 
most valuable application, and especially sys- 
temic remedy ; also, Potass. Bromide, 603. 

Strangury : 

Opium, 5S1, the tincture by enema, or, better, 
morphine subcutaneously. Gelsemium, 61S. 
Aconite, 657, Yeratrum Yiride, 663, and Bro- 
mides, 603, afford relief in varying degree. For 
vesical strangury, Cantharides Tincture, 740, 
Turpentine, 723, and various urino -genital 
remedies, and the antiseptics, Antipyrine, SSS, 
Benzoic Acid, 390, and Acetanilide, 395. 

Stricture : 
Electrolysis, 428, the most effective remedy 
known if properly applied. 

Strychnine-Poisoning : 
Emetics or Stomach- Pump ; Tannin, Com- 
pound Solution of Iodine, chemical antidotes, 
Chloral, Chloroform by inhalation, Nicotine, 
subcutaneously, physiological antagonists. 
Rest, Artificial Respiration, and Galvanism, 
432. 

Suppuration : 
Alcohol, 529, a powerful antiseptic and antipy- 
retic, and, externally, a valuable antiseptic 
dressing. Carbolic Acid, 357, and the Anti- 
septics in general. Quinine, 190, in full doses, 
as a tonic. Sulphites, 235, and Sidphides, 237, 
small doses frequently mature abscesses, and 
under some circumstances abort them ; also, 
Sulphurous Mineral- Waters, 241, Phos- 
phates, 130, and Lime Salts, 212, to repair waste 
by suppuration. Iodides of Iron and Manga- 
nese, 145, the sirup of. in the systemic depres- 
sion caused by suppuration. 

Sweating. (Hyperidrosis— see Perspiration.) 
Mineral Acids, 109. especially aromatic sulphuric 
acid. Oxide of Zinc, 301, in night-sweats of 



CLINICAL INDEX. 



799 



phthisis, especially with extract of belladonna. 
Gallic Acid, 322, restrains sweating, Atro- 
pine, 4S7, is a powerful means of arresting per- 
spiration; also, Duboisia, 498, and especially 
Picrotoxin, 447, Pilocarpus, 627, Resorcin; 
376, and Salicylic Acid, 371, cause sweating, 
and, under some conditions, arrest it. 

Sycosis: 

Carbolic Acid, 356, internally and externally. 
Oleate of Mercury, 277. 

Synovitis : 

Cod-liver Oil, 116, is useful in strumous and de- 
bilitated constitutions. Nitrate of Silver, 287, 
in nitrous ether, painted over the joint. Car- 
bolic Acid, 356, solution injected into the joint. 
Oleate of Mercury and Morphine, 277, Mas- 
sage, 94. 

Syphilis : 
Baths, 77, Turkish baths, wet packs, and vapor- 
baths, are very important in promoting excre- 
tion. Penutrition, or hunger-cure, 45. Cod- 
Uver Oil, 116, useful in chronic cases and 
broken-down constitutions. Mercury, 273, the 
great remedy for constitutional syphilis— by 
stomach, by inunction, by fumigation, or sub- 
cutaneously. Iodides, 248, in constitutional, 
certain forms of secondary and tertiary disease, 
are unrivaled in efficacy. Aurum, 280, comes 
into use after iodides and mercury, to which 
it is greatly inferior. Iron, 139, especially the 
iodide, in sloughing phageda?na and in depressed 
states of the system at all stages. Iodoform, 
252, as a local application to chancres. Car- 
bolic Acid, 357, Salicylic Acid, 372, Boracic 
Acid, 388, Benzoin, 390, Chlorate of Potassa, 
214, in powder, are valuable local applications 
to syphilitic sores, abscesses, discharging bu- 
boes, phagedena, etc. Sarsaparilla, 331, Stil- 
lingia, 333, Guaiacum, 334, are important 
adjuncts, vehicles, and remedies for the con- 
stitutional disease, the system being unequal to 
further iodine and mercurial treatment. 

T^eni.e : 
The various Tceniafuges, 716 et seq., Carbolic 
Acid, 357, Resorcin, 376, and Salicylic Acid, 
372, have killed taenia, so that a purgative only 
was necessary. Chloroform, 548, lately much 
used. Turpentine, 721, is one of the most effi- 
cient remedies, although unpleasant in the 
highest degree. Ailanthus, 669, has succeeded. 
Papain, 100, and other digestive ferments. 

Tetanus : 
Atropine, 4S8, injected into the rigid muscles, has 
done good. Strychnine, 439, is alleged to be 
curative in some cases, but more than doubtful. 
Chloral, 56S, is certainly a remedy of great 
value. Amyl Nitrite, 649, has been used with 
success; Nitro- Glycerin, 652, should also be 
fairly tried. Gelsemium, 617, has succeeded, 
and is a promising remedy. Curara, 612, val- 
uable, but uncertain. Bromide of Potassium, 
599, seems to be the most successful remedy. 
Physostigma, 632, has also been used with 
advantage in a number of cases, but its real 
value remains to be determined. Ryoscyam ine, 
495, or Duboisine, 498, may be used. Nicotine, 



638, has effected a cure, but its use requires 
cjiution. Anaesthetics, 558, give temporary re- 
lief. Morphine, 583, injected into the tetanized 
muscles, gives great relief. New remedies that 
have proved useful are Paraldehyde, 538, 
Urethan, 541, and Eypnone, 542, especially the 
first named. 

Thermic Fever, or Sunstroke: 

Cold Baths, 70, for the hyperpyrexia. Morphine, 
5S3, subcutaneously, when convulsions occur, 
or the insensibility and high temperature per- 
sist. Pilocarpine, 626, should be tried. Qui- 
nine, 192, Antipyrine, 383, Salol, 3S0, Ace- 
tanilide, 394, and other antipyretics should be 
administered subcutaneously. 

Thrombosis and Embolism : 
Ammonia, 227, by the stomach or by intravenous 
injection, to liquefy the obstructing clot. Er- 
got, 455, Quinine, 192, and Digitalis, 468, for 
the collateral hyperemia and oedema. 

Tic-Douloureux. (See Neuralgia.) 
Atropine and Morphine, 587, 590, these alkaloids 
in combination subcutaneously give relief. 
Croton- Chloral, 570, has special effects on the 
fifth nerve. Aconitine, 658, has lately been 
given with good results. Galvanism and Mag- 
netism relieve the pain, 425. Antipyrine, 383, 
and Acetanilide, 394, for pains of locomotor 
ataxia and of neuritis. 

Tinea : - 
Boracic Acid, 388, is an excellent topical appli- 
cation. Mercury, 278, corrosive sublimate, as 
an ointment or lotion for tinea tonsurans ; oleate 
of mercury in oleic acid, also, 277, of Copper, 
292, and an ointment of the carbonate. Car- 
bolic Acid, 356, applied directly or in glycerin 
to the part affected. Sulphites, 230, in solu- 
tion, also useful. Sulphides, 238, sulphur- 
baths, 227, faithfully carried on, are curative. 

Tonsillitis : 
Aconite, 657, the tincture of the root, in cases ac- 
companied by fever. Guaiacum, 333, a full 
dose is said to abort an attack. ' Ice, 73, held 
against the inflamed part, diminishes the con- 
gestion. Mercury, 276, small doses of calo- 
mel or gray powder reduce the inflammation. 
Quinine, 190, in a full dose at the outset may 
abort an attack. Alum, 316, in powder, solu- 
tion, or whey, does good after the acute 
symptoms. Tincture of Iodine, 252, inject- 
ed, will gradually diminish the hypertrophied 
tonsil. 

Toothache : 
Alum, 316, a solution in nitrous ether is said to 
be effectual. Tannin, 323, dissolved in ether, 
also relieves the pains of a carious tooth. Car- 
bonate of Soda, 214, a saturated solution held 
in the mouth relieves. Opium, 587, or mor- 
phine, a solution of, put in a carious cavity. Oil 
of Cloves, 395, Carbolic Acid, 356, or Resor- 
cin, 376, and Phenoresorcin, put in a cavity 
stops the pain. Xanthoxylum, 339, is a do- 
mestic remedy. 

Torticollis : 

Galvanism, 425, to the muscles in a state of 
spasm, and faradic applications to the antago- 



800 



CLINICAL INDEX 



nist muscles in a paretic state. 3Iassage, 94, 
Water. 73, hot douche. 

Tuberculosis : 
Grape- Cure, 52, Whey-Cure, 56, Cod-liver Oil, 
115. Iron, 141, valuable in so far as it improves 
nutrition. Creosote, 354, Iodoform, 259. Io- 
dide of Iron and Manganese, 149. Chloride 
of Calcium, 212, apparently exercises a real 
curative influence. 

Typhlitis : 
Ice, SO, in form of a poultice to the seat of in- 
flammation. Opium, 583, in form of enemata 
of the tincture, or deodorized tincture by the 
stomach, or morphine subcutaneously, which is 
the most effective. Leeches, 755, to the in- 
flamed region as soon as tenderness is mani- 
fest, and should not be omitted unless the sub- 
ject is feeble. Purgatives, 692, saline, especial- 
ly Epsom salts, alone admissible in typhlitis 
due to impaction of the caecum, and positively 
contra-indicated in the other forms of the dis- 
ease. 

Typhoid Fevee. (See Fever.) 
Aliment, 5S, a milk-diet, usually most suitable. 
Acids, Mineral, 103, the muriatic, has been 
much employed as a remedy to diminish fever 
and restrain diarrhoea. Iodine, 249, in the 
form of the compound tincture or solution, is 
a remedy of great value — lessens the violence 
and shortens the duration (German "Specific 
Treatment"). Mercury, 273, calomel in ten- 
grain doses for several days during the first 
week or ten days— " specific treatment" — 
shortens the duration and moderates the vio- 
lence of the disease. Carbolic Acid, 356. and 
creosote have been used with great success ; 
may be administered with iodine advantageous- 
ly. Chlorine, 344. The antipyretic and anti- 
septic treatment includes, besides the remedies 
just named, Quinine, 183, in large doses, Cold 
Baths, 74, Salicylic Acid, 354, Resorciri, 375, 
Benzoate of Sodium, 390, Arnica, 620, and 
Digitalis, 466. Nitrate of Silver, 2S6, Bis- 
muth, 153, Fowler's Solution with Tincture 
of Opium, 161, are employed to restrain diar- 
rhoea. 

TJlcees : 
Nitric Acid, 111. a powerful escharotic, used to 
destroy unhealthy tissues and change the char- 
acter of the surface. Potassa Chlorate, 215, 
in powder, applied to the surface, is remarkably 
beneficial in cases of unhealthy ulceration, in 
epithelioma, etc. Alum, 316, dried, is a feeble 
escharotic, and destroys unhealthy granula- 
tions. Zinc Sulphate, 302, dried, is a valuable 
caustic, and easily mannged; the chloride of 
zinc is more powerful and penetrating, as well 
as more painful. Pyrogallic Acid, 326. Po- 
tassa Fusa, 215, or the milder Vienna paste, 
diffuses widely and destroys deeply. Nitrate 
of Silver, 286, acts superficially, and is there- 
fore to be used only when the mildest effects 
are necessary. Sulphate of Copper, 291, is, 
like silver nitrate, a good application to change 
the character of an indolent ulcer, and to form 
a thin coating under which healing may pro- 



ceed. Iodoform, 260, 254, in powder, dusted 
over the ulcer, is a capital dressing for syphilitic 
ulcers, irritable sores, and superficial ulcers gen- 
erally; its odor for these purposes may be 
covered by thymol, menthol, or eucalyptol. 
Carbolic Acid, 356, Salicylic Acid, 354, 
Boracic Acid, 338, Resorcin, 875, Thymol, 
396, Chlorine, 344, are antiseptic, deodorant, 
and alterative applications, of great value in 
wounds, unhealthy ulceration, and sloughing 
phagedsena. Galvanism, 430, a galvanic coup- 
let, will heal bed-sores and unhealthy ulcers. 

TJejsmia : 

Water, 74, the vapor-bath, and hot -water pack, to 
excite the skin and promote free diaphoresis. 
Pilocarpus, 627, Muscarine, 672, and Resor- 
cin, 375, active diaphoretics, especially the first 
named, but the state of the heart must be care- 
fully watched — a weak or fatty heart being a 
positive contra-indication. Digitalis, 467, the 
infusion, an important means of procuring free 
action of the kidneys. Saline, 692, or Bydra- 
gogue Cathartics, 706 et seq., are of great 
importance to secure elimination by the in- 
testinal canal, and to relieve the blood-pressure. 
Colchicum. 329, is an excellent hydragogue 
and derivative in these cases : is best when 
combined with other purgatives. Morphine, 
5S4. hypodermatically, in full doses, is of re- 
markable value in urasmic convulsions. 

Uric- Acid Diathesis : 
Aliment, 62, the acid fruits and starchy foods are 
proper, but meats and other nitrogenous mate- 
rials objectionable. "When excess of uric acid 
is due to deficient oxidation, Nitric Acid, 
110, especially is of the greatest value; also 
muriatic and lactic acids. Alkalies, 207, the 
potash salts, particularly after meals ; also the 
Alkaline Waters, 218. Air, 90, Massage, 93. 

Urine, Incontinence of : 
Belladonna, 436, the most important remedy, 
and the alkaloid Atropine is the best prepara- 
tion, a quantity sufficient to induce its physio- 
logical effects being necessary. Ergot, 457. is 
effective when there is a paralytic sphincter, 
and in the case of diseased prostate. Iodide 
of Iron, 143. the sirup or official pill may be 
used ; it is successful in the case of pale, stru- 
mous, and feeble subjects. Strychnine, 439, 
may succeed when the other remedies fail; 
must be pushed, and is best adapted to cases 
characterized by great nerve mobility or weak- 
ness. When the urine is acid, a proper Diet, 
51, and Alkalies, 206; when alkaline, the 
Benzoate of Ammonia, 390. 

Uterine Colic : 
Aguapuncture, 750, gives surprising relief. Mor- 
phine and Atropine, 581, 590, subcutaneously. 
Camphor, 502, GeUemium, 618, and the ano- 
dynes derivative from alcohol. Chloral, 569, 
Ether, 545. Also Paraldehyde, 53S, Hypnone, 
542, Urethan, 541, etc. 

Uterus, Fibromata of: 
Ergotin, 457, subcutaneously and by stomach 
and rectum. Gold and Sodium Chloride, 
230, persistently used. Chloride of Calcium* 



CLINICAL INDEX. 



801 



212, also taken for a long time. Saline and al- 
terative Waters, 21S et seq. ; those of St. Catha- 
rine's, Canada, of Homburg and Kreutznach, 
etc. Iodine and Iodoform, 259, tincture and 
glycerites, 251, applied topically. Electrolysis, 
428. 

Uterus, Hypertrophy of; also, Sub-Involution : 
Ergot, 457, 459, fluid extract, and Cornutine, 458, 
subcutaneously, must be persistently admin- 
istered for a long time. Electricity, 428, Gal- 
vanism—an interrupted current, of great value 
in cases of simple enlargement. Iodoform, 
259, and lodo- Tannin, applied directly to the 
uterus, promote absorption. Gold and Sodi- 
um Chloride, 280, long continued in small 
doses, does much good. Phytolacca, 668, 
Digitalis, 468, and Cimicifuga, 478, are very 
useful in sub-involution. Ipecacuanha, 685, 
has remarkably good effects in recent cases of 
sub-involution, with menorrhagia or metror- 
rhagia. 

Uterus, Ulceration op: 
Hydrastis, 179, the fluid extract undiluted, freely 
applied, is a valuable application in cervicitis, 
endocervicitis, ulcer, and eversion. Iodo- Tan- 
nin, 252, iodoform and tannin packed around 
the cervix is a highly useful remedy in ulcer- 
ation and other disorders. Nitrate of Silver, 
288, a long-used and highly esteemed topical 
remedy, but has been much abused. Carbolic 
Acid, 356, pure, on cotton-wrapped probe, is a 
safe and efficient application in endocervicitis, 
endometritis, and ulcerations. Vegetable As- 
tringents, 323, oak, heuchera, hamamelis, ru- 
bus, etc., in the form of strong decoctions, in- 
jections, or fluid extracts, undiluted. Glycerite 
of Tannin, 323, 324, and Glycerin, 758, are 
useful in greater or less degree. 

Varicocele, and Varicose Veins : 
Ergot, 457, ergotin injected subcutaneously along- 
side the enlarged veins, an effective but painful 
expedient. The injection must not enter the 
veins. Same expedient can be practiced in the 
case of any varicose veins in an accessible situ- 
ation. 

Variola : 

Water, 76, Cold Baths for fever, especially hyper- 
pyrexia. Quinine, 192, small doses as a tonic, 
full doses for the suppuration, and antipyretic 
doses if the temperature is high. Ammonia 
Carbonate, 228, if there is manifest depres- 
Bion, and especially during the suppuration 
stage. Chloral, 568, is highly useful and ne- 
cessary when there are high temperature, wake- 
fulness, and delirium. Opium, 582, for wake- 
fulness, low delirium, and adynamia. Carbolic 
Acid, 356, Besorcin, 375, Salicylic Acid, 354, 
and Benzoate of Sodium, 390, are from the 
theoretical standpoint valuable antiseptics and 
antipyretics. Iodine, 251, tincture, is applied 
to pustules to prevent pitting. Silver Nitrate, 
2S6, a pointed stick of, is inserted into each pust- 
ule to abort it and thus prevent the formation 
of a cicatrix. 

Vomiting : 
Alcohol, 534, iced champagne or brandy in small 
52 



quantity frequently, will sometimes arrest vom- 
iting of pregnancy, of sea-sickness, of cholera, 
yellow fever, etc. Ether, 544, Chloroform, 547, 
a few drops frequently, will arrest some kinds 
of vomiting, as sea-sickness, passage of gall- 
stones, etc. Bromides, 597, are serviceable in 
cerebral vomiting, and in cholera infantum in 
children, and in some cases of reflex vomiting. 
Chloral, 567, highly useful in vomiting of sea- 
sickness, cholera, and reflex vomiting. Ipecacu- 
anha, 682, rarely in minute doses, will arrest 
some nervous and reflex attacks of vomiting. 
Arsenic, 160, drop-doses of Fowler's solution, 
will stop vomiting of irritative dyspepsia, of 
ulcer, etc. Hydrocyanic Acid, 644, can be pre- 
scribed in the vomiting of acute stomach 
troubles. Pepsin, 100, Milk and Lime- Water, 
212, Bismuth, 144, are proper in the vomiting of 
indigestion, of stomach inflammation, of acidity, 
and of acute intestinal disorders. Calomel, 
270, very minute doses of, will stop vomiting in 
cholera infantum and in other intestinal disor- 
ders in children. Oxalate of Cerium, 309, is 
one of the numerous remedies for the vomiting 
of pregnancy. Nitrate of Amyl and Nitro- 
Glycerin, 652, are said to be very effective in 
the vomiting of sea-sickness. Alkalies, 210, 
especially the effervescent powder. Nux Vomi- 
ca, 437,. the tincture, will sometimes succeed in 
atonic states. Creosote, Carbolic Acid, 353, 
has remarkably sedative effects, and will ar- 
rest the vomiting of acute stomachal and in- 
testinal disorders; it is advantageously com- 
bined with bismuth in an emulsion. Oxygen, 
342, and Hydrogen Dioxide, 343. 

Vomiting of Pregnancy : 
Cerium, 309, is a good remedy if given in full 
doses. Iodine, 245, a drop of the tincture, of 
the compound solution, or of the compound 
tincture, may succeed when other remedies 
fail. Carbolic Acid, 353, may succeed, but is 
uncertain, and its odor may excite disgust. 
Calumba, 169, a few drcps of the tincture may 
quiet the stomach quickly, but it often fails. 
Inglwoin, 97, has been frequently successful; 
also, Pepsin, 99, but is less useful than the 
former. Nux Vomica, 437, a drop or two of 
the tincture may prove beneficial. Arsenic, 
160, a drop of Fowler's solution, sometimes 
acts most favorably. Hydrocyanic Acid, 642, 
often does good and often fails. Alcohol, 534, 
as sparkling wine, may succeed temporarily. 
Oxygen, 342. 

Whooping-Cough : 
Atropine, 483, is a good remedy when secretion 
is profuse, and in the spasmodic stage ; decided 
physiological effects should be produced to have 
any curative action. Hyoscine,496. Bromides, 
602, give relief to the spasmodic condition— to 
the whoop— but do not much moderate the 
violence of the disease ; Bromide of Camphor, 
502, seems to be more useful. Hydrobromic 
Ether, 544, subcutaneously, by stomach, or by 
inhalation. Also the more recently discovered 
remedies, Paraldehyde, 538, Urethan, 541, 
Pyridine, 386, and Salol, 379, have much value. 



802 



CLINICAL INDEX. 



Chloral, 56S, is very useful at any stage, but 
is most serviceable during the spasmodic. 
Castanea, 322, a decoction of the leaves, may 
be taken at pleasure, and with certainty of 
some, although not marked, benefit. Nitric 
Acid, 110, sometimes benefits exceedingly, 
but is uncertain. Alum, 315, especially when 
there is a copious bronchial secretion. Lobe- 
lia, 640, when it acts as a nauseant. is most 
beneficial. Carbolic Acid, 356, by inhalation, 
seems to be a very valuable remedy. Ben- 
zoate of Sodium, 390, internally and by spray, 
is reported to be very serviceable. To these 
may be added Salicylates, Besorcin, Antipy- 
rine, Acetanilide, and other antiseptics, 340 
et seq. Lactucarium, 595, the sirup, is a use- 
ful vehicle for the exhibition of other medi- 
cines. AsafceUda, 505, a disagreeable but use- 
ful remedy, and may be given freely to infants 
and young children. Hydrocyanic Acid, 644, 
may be given during the spasm stage, but it is 



most efficacious as a remedy for the cough kept 
up by habit after the subsidence of the disease, 
and the cough by imitation. 

Woems. (See Pabasites.) 
Eucalyptus, 175. Calomel, 272, an excellent 
remedy to expel the round worm, and is best 
administered with santonin. Salicylic Acid, 
367, has been used successfully against taenia. 
Anthelmintics, 713 et seq. 

"Wounds : 
Lister's Method, 357, 372, 3S8, Water, Hydro- 
therapy, 75 et seq., cold and hot, as a dressing 
for wounds, to arrest haemorrhage, and, in form 
of baths, to depress abnormal heat. Alcohol, 
530, an excellent antiseptic and astringent 
dressing, and as a remedy in pyrexia. 

Wbiteb's Cbamp : 
Metallotherapy, 311. Faradism, 424. 

Yellow Fevee : 

Carbolic Acid, 354, Champagne, iced, 534, 
Turpentine, 721, for the vomiting. 



THE EM). 



A TREATISE 

ON THE 

PRACTICE OF MEDICINE, 

For the Use of Students and Practitioners. 

By ROBERTS BARTHOLOW, M. A., M. D, LL. D., 

Professor of Materia Medica and General Therapeutics in the Jefferson Medical College of Philadelphia' 

recently Professor of the Practice of Medicine and of Clinical Medicine in the Medical College 

of Ohio at Cincinnati, etc., etc. 



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up on a level with, and incorporates, the latest acquisitions of medical science, 
and may be depended on to contain the most recent information up to the date 
of publication. 

" As my treatise on ' Materia Medica and Therapeutics ' embraced those topics of im- 
portance to the physician, and omitted matters of rather extraneous interest, so, in the 
preparation of this volume, my purpose was to include the subjects embraced under the 
title of ' Practice of Medicine,' omitting those topics of general pathology, etiology, etc., 
with which the works on Practice usually open, and which, though sufficiently valuable 
in themselves, are too often passed over hastily, or not read at all, in the desire to reach 
* the practical subjects.' I have therefore omitted the topics in question from their posi- 
tion as an introduction to special pathology, and have, although at the disadvantage of 
some repetition, incorporated them in their proper relation with individual diseases. 

" Serving as an officer of the medical staff of the United States Army in Kansas, Utah, 
Colorado, New Mexico, Minnesota, and during the War of the Rebellion at Washington, 
Nashville, Chattanooga, Baltimore, etc., followed by an extensive practice (private and 
hospital) of sixteen years at Cincinnati, I may justly claim to have enjoyed large oppor- 
tunities for the clinical study of the diseases of the North American Continent. With 
one or two unimportant exceptions, I have had personal charge of the maladies treated 
of in this work, and have made them the subject of clinical demonstration and post-mortem 
investigation, either privately or in public lectures. 

" In the treatment of the various topics, I have attempted to give to each just that 
amount of consideration to which its importance entitles it, within the limitations imposed 
by the size of the work. A just harmony and proportion can be secured only by con- 
densing some subjects and displaying others. No space has been given to merely histor- 
ical disquisitions, or to the discussion of controverted points. Also, to utilize all available 
space, chapters have been dispensed with, and the intervals between the sections have 
been abbreviated as much as possible. Notwithstanding my utmost efforts at condensa- 
tion, the work has grown beyond the contemplated size ; but I would fain hope that no 
part of it could be sacrificed without impairing the value of the whole." — Extract from 
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A TREATISE ON INSANITY, IN ITS 

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A TREATISE ON THE DISEASES OF 

THE NERVOUS SYSTEM. 

Seventh edition, rewritten, enlarged, and improved. 

By WILLIAM A. HAMMOND, M. D., 

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convictions are positive, and he can set them forth clearly and attractively. _ It is not 
surprising that this book has been a very popular one. And the present edition is, as 
modestly stated on the title-page, ' improved.' " — Medical Record. 



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8 

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